1275794224 NPI number — DR. SAMMY DANIEL, DAVID EGHBALIEH M.D.

Table of content: DR. SAMMY DANIEL, DAVID EGHBALIEH M.D. (NPI 1275794224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275794224 NPI number — DR. SAMMY DANIEL, DAVID EGHBALIEH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EGHBALIEH
Provider First Name:
SAMMY
Provider Middle Name:
DANIEL, DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1275794224
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1530 CAMDEN AVE
Provider Second Line Business Mailing Address:
SUITE 403
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90025-8010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-991-7266
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19950 RINALDI ST # 101D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTER RANCH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91326-4141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
747-999-6827
Provider Business Practice Location Address Fax Number:
818-350-0555
Provider Enumeration Date:
06/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: A133688 , 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)





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