Taeho Im MD Inc

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

G66753 Issued in CA

Legal business name

TAEHO IM MD INC

Practice address

1700 Coffee Road
Modesto, CA 95355

Phone

(209) 526-4500

NPI assigned

Nov 21, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Taeho Im, MD INCNPI 1841203288

Title

President

Phone

(209) 480-3450

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Taeho Im, MD INC

  • Anesthesiology Physician
  • Modesto, CA
  • NPI 1841203288
  Medicare reassignment NPD Authorized official
• Lawrence Eugene Waspe, MD

  • Clinical Cardiac Electrophysiology Physician
  • Modesto, CA
  • NPI 1497718704
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711324800000",
    "number": "1053486498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "446 SELBY LN",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "945516346",
            "telephone_number": "209-480-3450",
            "fax_number": "209-529-6610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 COFFEE ROAD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "95355",
            "telephone_number": "209-526-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAEHO IM MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A",
        "authorized_official_last_name": "IM",
        "authorized_official_first_name": "TAEHO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-480-3450",
        "authorized_official_credential": "MD INC"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G66753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G667530",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcella Ann Tackett, ACSW
• Anessia Tacla
• Charlotte June Tacy, OT
• Julienne Tadena
• Miranda H. Tadesse Paniagua
• Guadalupe Tafolla
• Janet Tafolla
• Joanna Tafolla
• Rain Lancelot Taganas, DPT
• Negin Taher

• Anesthesiology Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.