Provider Demographics
NPI:1992774681
Name:TAHERI, DANIEL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:TAHERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 ARTESIA BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3207
Mailing Address - Country:US
Mailing Address - Phone:424-276-4700
Mailing Address - Fax:424-903-1099
Practice Address - Street 1:10884 SANTA MONICA BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4646
Practice Address - Country:US
Practice Address - Phone:310-446-4400
Practice Address - Fax:310-446-4408
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80445207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG80445OtherCALIFORNIA MEDICAL LICENSE
NV11900OtherNEVADA MEDICAL LICENSE
AZ37910OtherARIZONA MEDICAL LICENSE
CAWG80445BMedicare PIN
CAG80445OtherCALIFORNIA MEDICAL LICENSE
CAAU804ZMedicare PIN
NV103574Medicare PIN
AZ37910OtherARIZONA MEDICAL LICENSE
CAWG80445DMedicare PIN
CA00G804450Medicare PIN