MEDICARE: DR. HAMED TAHERI 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	2086S0129X	Vascular Surgery Physician	MD446301	PA
2	208600000X	Surgery Physician	274616	NY
3	208600000X	Surgery Physician	MD446301	PA
4	390200000X	Student in an Organized Health Care Education/Training Program		VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	A138318	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1679766745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAMED TAHERI M.D.

Provider Business Mailing Address
First Line	:	1045 ATLANTIC AVE STE 512
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3422
Country	:	US
Telephone Number	:	562-435-0862
Fax Number	:	562-435-0863

Provider Business Practice Location Address
First Line	:	1045 ATLANTIC AVE STE 512
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3422
Country	:	US
Telephone Number	:	562-435-0862
Fax Number	:	562-435-0863

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

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	12/18/2018

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Directions to “ DR. HAMED TAHERI M.D.” Practice Location

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