MEDICARE: TAHERI CHANG M.D., PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1114162559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAHERI CHANG M.D., PC

Provider Business Mailing Address
First Line	:	PO BOX 16297
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90209-2297
Country	:	US
Telephone Number	:	661-974-8666
Fax Number	:	661-974-8669

Provider Business Practice Location Address
First Line	:	5731 S FORT APACHE RD
Second Line	:	SUITE #103
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5620
Country	:	US
Telephone Number	:	702-346-3875
Fax Number	:	661-974-8669

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL TAHERI
Credential	:	M.D.
Telephone Number	:	661-974-8666

Provider Enumeration Date	:	12/15/2008
Last Update Date	:	06/08/2009

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