Provider Demographics
NPI:1467509687
Name:SAMOUHI, PAYAM (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:PAYAM
Middle Name:
Last Name:SAMOUHI
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22142 SHERMAN WAY
Mailing Address - Street 2:#201
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1136
Mailing Address - Country:US
Mailing Address - Phone:818-703-8200
Mailing Address - Fax:818-703-8296
Practice Address - Street 1:22142 SHERMAN WAY
Practice Address - Street 2:#201
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1136
Practice Address - Country:US
Practice Address - Phone:818-703-8200
Practice Address - Fax:818-703-8296
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOMS471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery