Individual
SOHA P. TAHERI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
91-2141 FORT WEAVER RD, EWA BEACH, HI 96706-1993
(808) 691-3000
Mailing address
91-2141 FORT WEAVER RD, EWA BEACH, HI 96706-1993
(808) 691-3000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
062008
GA
207R00000X
Internal Medicine Physician
Primary
MD-21941
HI
208M00000X
Hospitalist Physician
62008
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52305514-001
BCBS
GA
01
—
582162071-040
HMHS/TRICARE SOUTH
—
05
—
799561945A
—
GA
05
—
G62008
—
SC
01
—
P00687389
RR MEDICARE
GA
Enumeration date
09/13/2007
Last updated
08/11/2021
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