Provider Demographics
NPI:1518932474
Name:FARAG, SAMY S (MD)
Entity Type:Individual
Prefix:
First Name:SAMY
Middle Name:S
Last Name:FARAG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 781
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91012
Mailing Address - Country:US
Mailing Address - Phone:323-665-5600
Mailing Address - Fax:323-665-8500
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:#610
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-665-5600
Practice Address - Fax:323-665-8500
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA25821207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A258210Medicaid
A25821Medicare ID - Type Unspecified
A83289Medicare UPIN