Healthcare Provider Details

I. General information

NPI: 1295083939
Provider Name (Legal Business Name): ELHAM TAEED MD A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 BARRANCA PKWY STE 308
IRVINE CA
92604-4631
US

IV. Provider business mailing address

4950 BARRANCA PKWY STE 308
IRVINE CA
92604-4631
US

V. Phone/Fax

Practice location:
  • Phone: 949-548-5700
  • Fax: 949-288-0254
Mailing address:
  • Phone: 949-548-5700
  • Fax: 949-288-0254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA54363
License Number StateCA

VIII. Authorized Official

Name: ELHAM TAEED
Title or Position: PRESIDENT
Credential: MD
Phone: 949-548-5700