Provider Demographics
NPI:1821296351
Name:SAMUEL I. FINK, M.D., INC.
Entity Type:Organization
Organization Name:SAMUEL I. FINK, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-609-0700
Mailing Address - Street 1:5620 WILBUR AVE
Mailing Address - Street 2:SUITE 333
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1351
Mailing Address - Country:US
Mailing Address - Phone:818-609-0700
Mailing Address - Fax:818-705-3954
Practice Address - Street 1:5620 WILBUR AVE
Practice Address - Street 2:SUITE 333
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1351
Practice Address - Country:US
Practice Address - Phone:818-609-0700
Practice Address - Fax:818-705-3954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85719Medicare UPIN
CAW18312Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION