MEDICARE: JEREMIAH TAO 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	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	A99982	CA

General Provider Information

NPI Number	:	1841292257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMIAH TAO M.D.

Provider Business Mailing Address
First Line	:	850 HEALTH SCIENCES RD
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92697-4375
Country	:	US
Telephone Number	:	949-824-0327
Fax Number	:	949-824-4015

Provider Business Practice Location Address
First Line	:	850 HEALTH SCIENCES RD
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92697-4375
Country	:	US
Telephone Number	:	949-824-0327
Fax Number	:	949-824-4015

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	05/06/2016

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