Provider Demographics
NPI:1457590150
Name:TAHERI CHANG MD PC
Entity Type:Organization
Organization Name:TAHERI CHANG MD PC
Other - Org Name:MESQUITE DERMATOLOGY & SKIN CANCER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:TAHERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-974-8666
Mailing Address - Street 1:PO BOX 16297
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-2297
Mailing Address - Country:US
Mailing Address - Phone:661-974-8666
Mailing Address - Fax:661-974-8669
Practice Address - Street 1:5731 S FORT APACHE RD STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5620
Practice Address - Country:US
Practice Address - Phone:661-974-8666
Practice Address - Fax:661-974-8669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty