Healthcare Provider Details

I. General information

NPI: 1366708802
Provider Name (Legal Business Name): AMIR TAEFI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST DEPT OF GASTROENTEROLOGY & HEPATOLOGY
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

2238 GATEWAY OAKS DR APT 123
SACRAMENTO CA
95833-3218
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7183
  • Fax: 916-734-7908
Mailing address:
  • Phone: 919-534-6926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: