Provider Demographics
NPI:1619952637
Name:SAMADI, ALBERT A (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:A
Last Name:SAMADI
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:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5637
Mailing Address - Fax:818-837-5589
Practice Address - Street 1:23929 MCBEAN PKWY
Practice Address - Street 2:SUITE #200
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4466
Practice Address - Country:US
Practice Address - Phone:661-290-5320
Practice Address - Fax:661-290-5321
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211535208800000X
CAA96238208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02287272Medicaid
CA00A962380Medicaid
358271Medicare ID - Type Unspecified
CAWA96238AMedicare PIN
H72314Medicare UPIN