Provider Demographics
NPI:1871939587
Name:SAIFULLAH, TAHER MIR (MD)
Entity type:Individual
Prefix:
First Name:TAHER
Middle Name:MIR
Last Name:SAIFULLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 S FAIR OAKS AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2663
Mailing Address - Country:US
Mailing Address - Phone:626-469-2939
Mailing Address - Fax:626-469-2956
Practice Address - Street 1:625 S FAIR OAKS AVE STE 230
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2663
Practice Address - Country:US
Practice Address - Phone:626-469-2939
Practice Address - Fax:626-469-2956
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036143421207LP2900X
CAA153944207LP2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty