Modesto Dermatology and Skin Cancer PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

MODESTO DERMATOLOGY AND SKIN CANCER PC

Practice address

3105 McHenry Ave
Modesto, CA 95350-1439

Phone

(209) 575-2700

NPI assigned

Jun 29, 2012

Last updated

Jun 29, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Daniel Taheri, MDNPI 1992774681

Title

President

Phone

(209) 575-2700

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Daniel Taheri, M.D.

  • Dermatology Physician
  • Los Angeles, CA
  • NPI 1992774681
  NPD (past) Authorized official

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

{
    "created_epoch": "1340928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340928000000",
    "number": "1093079485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 496084",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960496084",
            "telephone_number": "209-575-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3105 MCHENRY AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953501439",
            "telephone_number": "209-575-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODESTO DERMATOLOGY AND SKIN CANCER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-29",
        "last_updated": "2012-06-29",
        "status": "A",
        "authorized_official_last_name": "TAHERI",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-575-2700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FNP",
            "identifier": "FNP42965",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Modesto Advanced Diagnostic Imaging Medical Center (Modesto Advanced Diag Imaging Medical Center)
• Modesto Anesthesia Medical Group
• Modesto Arts Medical Group, Inc.
• Modesto Chiropractic Center, a Rosen Family Corp. (Modesto Chiropractic Center)
• Modesto City Schools
• Modesto Drug LLC (Modesto Pharmacy)
• Modesto Eye Center Inc
• Modesto Fire Department
• Modesto Gastroenterology Medical Corporation
• Modesto Gospel Mission

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.