Provider Demographics
NPI:1295083939
Name:ELHAM TAEED MD A MEDICAL CORP
Entity type:Organization
Organization Name:ELHAM TAEED MD A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TAEED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-548-5700
Mailing Address - Street 1:4950 BARRANCA PKWY STE 308
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4631
Mailing Address - Country:US
Mailing Address - Phone:949-548-5700
Mailing Address - Fax:949-288-0254
Practice Address - Street 1:4950 BARRANCA PKWY STE 308
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4631
Practice Address - Country:US
Practice Address - Phone:949-548-5700
Practice Address - Fax:949-288-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X
CAA54363261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA54363OtherPROFESSIONAL STATE LICENSE