1740429588 NPI number — AFSHIN SAMET MD PROF CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740429588 NPI number — AFSHIN SAMET MD PROF CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFSHIN SAMET MD PROF CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740429588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 390005
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92149-0005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-746-6530
Provider Business Mailing Address Fax Number:
619-746-6528

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1429 E THOUSAND OAKS BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
THOUSAND OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91362-2801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-277-2437
Provider Business Practice Location Address Fax Number:
805-277-2437
Provider Enumeration Date:
02/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SAMET
Authorized Official First Name:
AFSHIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
805-277-2437

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  0036364 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: A54105 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1609896463 . This is a "INDIVIUAL NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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