Provider Demographics
NPI:1275794224
Name:EGHBALIEH, SAMMY DANIEL, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMMY
Middle Name:DANIEL, DAVID
Last Name:EGHBALIEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1530 CAMDEN AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-8010
Mailing Address - Country:US
Mailing Address - Phone:310-991-7266
Mailing Address - Fax:
Practice Address - Street 1:19950 RINALDI ST # 101D
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4141
Practice Address - Country:US
Practice Address - Phone:747-999-6827
Practice Address - Fax:818-350-0555
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1336882086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program