Provider Demographics
NPI:1568466100
Name:SAMPSON, MICHAEL SEAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SEAN
Last Name:SAMPSON
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 1:3919 BEVERLY BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3432
Mailing Address - Country:US
Mailing Address - Phone:323-953-2956
Mailing Address - Fax:323-913-2588
Practice Address - Street 1:3919 BEVERLY BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3432
Practice Address - Country:US
Practice Address - Phone:323-953-2956
Practice Address - Fax:323-913-2588
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84548207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G845481Medicaid
CA00G845481Medicaid
CAG84548Medicare ID - Type Unspecified