Healthcare Provider Details

I. General information

NPI: 1780624619
Provider Name (Legal Business Name): YAHYA JOHN TALIEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SPANOS CT SUITE 203
MODESTO CA
95355-2810
US

IV. Provider business mailing address

PO BOX 577134
MODESTO CA
95357-7134
US

V. Phone/Fax

Practice location:
  • Phone: 209-522-0600
  • Fax: 209-491-0116
Mailing address:
  • Phone: 209-522-0600
  • Fax: 209-491-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA73331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: