Healthcare Provider Details

I. General information

NPI: 1770759177
Provider Name (Legal Business Name): AMIR H TAHERNIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 N ROBERTSON BLVD
BEVERLY HILLS CA
90211
US

IV. Provider business mailing address

9735 WILSHIRE BLVD STE 421
BEVERLY HILLS CA
90212-2113
US

V. Phone/Fax

Practice location:
  • Phone: 310-614-9701
  • Fax: 213-260-2313
Mailing address:
  • Phone: 310-480-8268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA77142
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number134557
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: