Provider Demographics
NPI:1477113728
Name:SHOKUHFAR, TAHA AMIN (MD)
Entity type:Individual
Prefix:
First Name:TAHA
Middle Name:AMIN
Last Name:SHOKUHFAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TAHAAMIN
Other - Middle Name:
Other - Last Name:SHOKUHFAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:625 FAIR OAKS AVE STE 175
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2683
Mailing Address - Country:US
Mailing Address - Phone:626-598-3770
Mailing Address - Fax:
Practice Address - Street 1:625 FAIR OAKS AVE STE 175
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2683
Practice Address - Country:US
Practice Address - Phone:626-598-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3443302084N0400X
MTMED-PHYS-LIC-1418232084N0400X
CAA1867812084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology