Provider Demographics
NPI:1740429588
Name:AFSHIN SAMET MD PROF CORP
Entity Type:Organization
Organization Name:AFSHIN SAMET MD PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AFSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-277-2437
Mailing Address - Street 1:PO BOX 390005
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92149-0005
Mailing Address - Country:US
Mailing Address - Phone:619-746-6530
Mailing Address - Fax:619-746-6528
Practice Address - Street 1:1429 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2801
Practice Address - Country:US
Practice Address - Phone:805-277-2437
Practice Address - Fax:805-277-2437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0036364207P00000X
CAA54105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609896463OtherINDIVIUAL NPI
CA1609896463OtherINDIVIUAL NPI