1730316548 NPI number — DR. NADIV YEHOSHUA SAMIMI M.D.

Table of content: DR. NADIV YEHOSHUA SAMIMI M.D. (NPI 1730316548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730316548 NPI number — DR. NADIV YEHOSHUA SAMIMI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAMIMI
Provider First Name:
NADIV
Provider Middle Name:
YEHOSHUA
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:
1730316548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1964 WESTWOOD BLVD
Provider Second Line Business Mailing Address:
SUITE 435
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90025-4651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-856-9488
Provider Business Mailing Address Fax Number:
310-817-6402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1964 WESTWOOD BLVD
Provider Second Line Business Practice Location Address:
SUITE 435
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-4651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-856-9488
Provider Business Practice Location Address Fax Number:
310-817-6402
Provider Enumeration Date:
06/18/2009

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: 207L00000X , with the licence number:  A108143 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: A108143 , 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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