Provider Demographics
NPI:1770759177
Name:TAHERNIA, AMIR H (MD)
Entity type:Individual
Prefix:MR
First Name:AMIR
Middle Name:H
Last Name:TAHERNIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9735 WILSHIRE BLVD
Mailing Address - Street 2:STE 421
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2113
Mailing Address - Country:US
Mailing Address - Phone:310-480-8268
Mailing Address - Fax:
Practice Address - Street 1:145 N ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-614-9701
Practice Address - Fax:213-260-2313
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1345572086S0122X
CAA77142208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery