Provider Demographics
NPI:1366815524
Name:TARYNE IMAI M D A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:TARYNE IMAI M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TARYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:IMAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-779-5718
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-0261
Mailing Address - Country:US
Mailing Address - Phone:808-779-5718
Mailing Address - Fax:
Practice Address - Street 1:150 N ROBERTSON BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2142
Practice Address - Country:US
Practice Address - Phone:808-779-5718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98091208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty