Healthcare Provider Details

I. General information

NPI: 1679766745
Provider Name (Legal Business Name): HAMED TAHERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 ATLANTIC AVE STE 512
LONG BEACH CA
90813-3422
US

IV. Provider business mailing address

1045 ATLANTIC AVE STE 512
LONG BEACH CA
90813-3422
US

V. Phone/Fax

Practice location:
  • Phone: 562-435-0862
  • Fax: 562-435-0863
Mailing address:
  • Phone: 562-435-0862
  • Fax: 562-435-0863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD446301
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number274616
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD446301
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: