Healthcare Provider Details

I. General information

NPI: 1992774681
Provider Name (Legal Business Name): DANIEL TAHERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10884 SANTA MONICA BLVD 3RD FLOOR
LOS ANGELES CA
90025-4646
US

IV. Provider business mailing address

2409 ARTESIA BLVD FL 2
REDONDO BEACH CA
90278-3207
US

V. Phone/Fax

Practice location:
  • Phone: 310-446-4400
  • Fax: 310-446-4408
Mailing address:
  • Phone: 424-276-4700
  • Fax: 424-903-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG80445
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberG80445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: