Provider Demographics
NPI:1851385223
Name:KABBANI, SAMER (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:
Last Name:KABBANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOUHAMAD
Other - Middle Name:SAMER
Other - Last Name:KABBANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2332 23RD ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3231
Mailing Address - Country:US
Mailing Address - Phone:707-444-8011
Mailing Address - Fax:
Practice Address - Street 1:2332 23RD ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3231
Practice Address - Country:US
Practice Address - Phone:707-444-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35090479207RC0000X
FLME113226207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008638300Medicaid
OH2814468Medicaid
OHP00458216OtherRAIROAD MEDICARE
OHKA7381571Medicare PIN
FLGZ779ZMedicare PIN