Healthcare Provider Details

I. General information

NPI: 1033220835
Provider Name (Legal Business Name): SHAHRAM TAHERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10921CHERRY STREET SUITE 100
LOS ALAMITOS CA
90720
US

IV. Provider business mailing address

10921 CHERRY ST STE 200
LOS ALAMITOS CA
90720-2473
US

V. Phone/Fax

Practice location:
  • Phone: 562-795-5600
  • Fax:
Mailing address:
  • Phone: 562-594-5996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA52355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: