Provider Demographics
NPI:1124187513
Name:SHAHIN HOSSEINZADEH SAMIMI MD PC
Entity Type:Organization
Organization Name:SHAHIN HOSSEINZADEH SAMIMI MD PC
Other - Org Name:COASTAL DIAGNOSTIC PATHOLOGY INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SAMIMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-850-4970
Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:2701 S BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6201
Practice Address - Country:US
Practice Address - Phone:800-288-8325
Practice Address - Fax:419-866-5453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35793207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A357930Medicaid
CA00A357930Medicaid