Healthcare Provider Details

I. General information

NPI: 1922144450
Provider Name (Legal Business Name): DANIEL TAHERI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
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: 800-991-6448
  • Fax:
Mailing address:
  • Phone: 800-991-6448
  • Fax: 661-974-8669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL TAHERI
Title or Position: CEO
Credential: MD
Phone: 661-388-5240