Provider Demographics
NPI:1518141951
Name:SAM SANANDAJI, DPM
Entity Type:Organization
Organization Name:SAM SANANDAJI, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SANANDAJI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-657-2828
Mailing Address - Street 1:8631 W 3RD ST
Mailing Address - Street 2:SUITE 940 E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:310-657-2828
Mailing Address - Fax:310-657-9733
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE 940 E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-657-2828
Practice Address - Fax:310-657-9733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4652261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4652Medicare UPIN