Provider Demographics
NPI:1033278031
Name:SAM, JOHN I (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:I
Last Name:SAM
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 1:3342 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-2206
Mailing Address - Country:US
Mailing Address - Phone:323-267-1214
Mailing Address - Fax:323-267-0282
Practice Address - Street 1:3342 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2206
Practice Address - Country:US
Practice Address - Phone:323-267-1214
Practice Address - Fax:323-267-0282
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A449460Medicaid
E02543Medicare UPIN
CA00A449460Medicaid