Provider Demographics
NPI:1508893421
Name:KANNANGARA, SAMAN (MD)
Entity Type:Individual
Prefix:
First Name:SAMAN
Middle Name:
Last Name:KANNANGARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CODOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1199 BUSH ST STE 400
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5975
Practice Address - Country:US
Practice Address - Phone:415-379-2980
Practice Address - Fax:415-346-6025
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC163234207RI0200X
PAMD423597207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012333400001Medicaid
PA133665Medicare PIN
NJ147223Medicare PIN
I36333Medicare UPIN
PA093187ZA3DMedicare PIN
NJ147642ZC2VMedicare PIN
NJ147223Medicare PIN