Provider Demographics
NPI:1841381712
Name:SAMIMI, DARYOOSH (MD)
Entity Type:Individual
Prefix:
First Name:DARYOOSH
Middle Name:
Last Name:SAMIMI
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:PO BOX 9870
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-9870
Mailing Address - Country:US
Mailing Address - Phone:714-546-3898
Mailing Address - Fax:714-754-4401
Practice Address - Street 1:17150 EUCLID ST
Practice Address - Street 2:SUITE 220
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4092
Practice Address - Country:US
Practice Address - Phone:714-546-3898
Practice Address - Fax:714-754-4401
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34931174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A349310Medicaid
CAA34931Medicare PIN
CA00A349310Medicaid