Provider Demographics
NPI:1043862238
Name:SAMAN SABOUNCHI LLC
Entity Type:Organization
Organization Name:SAMAN SABOUNCHI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SABOUNCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-618-8479
Mailing Address - Street 1:545 MORSE AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-3653
Mailing Address - Country:US
Mailing Address - Phone:832-618-8479
Mailing Address - Fax:
Practice Address - Street 1:1355 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-4307
Practice Address - Country:US
Practice Address - Phone:832-618-8479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY292859OtherNYSED