Provider Demographics
NPI:1790017218
Name:FAKHERI, SAMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMAN
Middle Name:
Last Name:FAKHERI
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 1:17075 DEVONSHIRE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-5407
Mailing Address - Country:US
Mailing Address - Phone:818-923-5453
Mailing Address - Fax:310-593-2521
Practice Address - Street 1:17075 DEVONSHIRE ST STE 201
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-5405
Practice Address - Country:US
Practice Address - Phone:818-923-5453
Practice Address - Fax:310-593-2521
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107753207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine