MEDICARE: DR. MICHAEL TAHERY M.D.

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	174400000X	Specialist	G78228	CA
2	207VG0400X	Gynecology Physician	G78228	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G78228	OTHER	CA	MEDICAL LICENSE
2	1346249539	OTHER	CA	NPI NUMBER

General Provider Information

NPI Number	:	1346249539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL TAHERY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 16376
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90209-2376
Country	:	US
Telephone Number	:	818-265-9499
Fax Number	:	818-548-0447

Provider Business Practice Location Address
First Line	:	10884 SANTA MONICA BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-7639
Country	:	US
Telephone Number	:	818-296-9499
Fax Number	:	818-548-0447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	05/23/2023

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Directions to “ DR. MICHAEL TAHERY M.D.” Practice Location

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