Provider Demographics
NPI:1780624619
Name:TALIEH, YAHYA JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:YAHYA
Middle Name:JOHN
Last Name:TALIEH
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:PO BOX 577134
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-7134
Mailing Address - Country:US
Mailing Address - Phone:209-522-0600
Mailing Address - Fax:209-491-0116
Practice Address - Street 1:1401 SPANOS CT
Practice Address - Street 2:SUITE 203
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2810
Practice Address - Country:US
Practice Address - Phone:209-522-0600
Practice Address - Fax:209-491-0116
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73331174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A733310Medicaid
CAH30307Medicare UPIN
CA00A733310Medicaid