Provider Demographics
NPI:1841292257
Name:TAO, JEREMIAH (MD)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:TAO
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 1:850 HEALTH SCIENCES RD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697-4375
Mailing Address - Country:US
Mailing Address - Phone:949-824-0327
Mailing Address - Fax:949-824-4015
Practice Address - Street 1:850 HEALTH SCIENCES RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-4375
Practice Address - Country:US
Practice Address - Phone:949-824-0327
Practice Address - Fax:949-824-4015
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99982207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INI33024Medicare UPIN
IN087020NMedicare ID - Type Unspecified