Provider Demographics
NPI:1932609054
Name:HAYTOGLU, TAHIR (MD)
Entity Type:Individual
Prefix:
First Name:TAHIR
Middle Name:
Last Name:HAYTOGLU
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 1:9471 HAVEN AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5818
Mailing Address - Country:US
Mailing Address - Phone:909-474-2333
Mailing Address - Fax:
Practice Address - Street 1:9471 HAVEN AVE STE 140
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5818
Practice Address - Country:US
Practice Address - Phone:909-474-2333
Practice Address - Fax:909-944-8111
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291773207RE0101X
CAA72482207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05228184Medicaid
PA103544920Medicaid