Provider Demographics
NPI:1760406169
Name:BAKSHIAN, SAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:BAKSHIAN
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 1:6330 SAN VICENTE BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5425
Mailing Address - Country:US
Mailing Address - Phone:310-855-0751
Mailing Address - Fax:310-358-2453
Practice Address - Street 1:6330 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5425
Practice Address - Country:US
Practice Address - Phone:310-855-0751
Practice Address - Fax:310-358-2453
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77202207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5982150001Medicare NSC
CAEY195ZMedicare PIN
CAF73858Medicare UPIN