Healthcare Provider Details

I. General information

NPI: 1467216309
Provider Name (Legal Business Name): DANIEL TAHERI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 BOX CANYON DR
LAS VEGAS NV
89128-0450
US

IV. Provider business mailing address

PO BOX 16297
BEVERLY HILLS CA
90209-2297
US

V. Phone/Fax

Practice location:
  • Phone: 702-639-8585
  • Fax: 562-250-5285
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DANIEL TAHERI
Title or Position: CEO
Credential: MD
Phone: 26-397-8585