Provider Demographics
NPI:1851177612
Name:SOM MEDICAL SERVICES
Entity Type:Organization
Organization Name:SOM MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIFIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-766-7546
Mailing Address - Street 1:25 E E ST
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3620
Mailing Address - Country:US
Mailing Address - Phone:760-766-7546
Mailing Address - Fax:
Practice Address - Street 1:25 E E ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3620
Practice Address - Country:US
Practice Address - Phone:760-766-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty