Provider Demographics
NPI:1326235334
Name:FARZIN SAMADI, MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FARZIN SAMADI, MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-308-3500
Mailing Address - Street 1:PO BOX 241424
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-9224
Mailing Address - Country:US
Mailing Address - Phone:310-308-3500
Mailing Address - Fax:
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:540E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-308-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16763Medicare PIN