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Organization
TAEHO IM MD INC
Active
Organization
TAEHO IM MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAEHO IM MD INC (PRESIDENT)
(209) 480-3450
Entity
Organization
Contact information
Practice address
1700 COFFEE ROAD, MODESTO, CA 95355
(209) 526-4500
Mailing address
446 SELBY LN, LIVERMORE, CA 94551-6346
(209) 480-3450
(209) 529-6610
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G66753
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G667530
—
CA
Enumeration date
11/21/2006
Last updated
03/25/2024
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