Provider Demographics
NPI:1750303111
Name:MASKET, SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:MASKET
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 1:2080 CENTURY PARK EAST
Mailing Address - Street 2:SUITE # 911
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2012
Mailing Address - Country:US
Mailing Address - Phone:310-229-1220
Mailing Address - Fax:310-229-1222
Practice Address - Street 1:2080 CENTURY PARK EAST
Practice Address - Street 2:SUITE # 911
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2012
Practice Address - Country:US
Practice Address - Phone:310-229-1220
Practice Address - Fax:310-229-1222
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207W00000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG33781DMedicare PIN
CAA45675Medicare UPIN
CAWG33781CMedicare PIN
CA00G337810Medicaid