Provider Demographics
NPI:1851496475
Name:SAMPAT, JAYSHREE HEMANT (MD)
Entity Type:Individual
Prefix:
First Name:JAYSHREE
Middle Name:HEMANT
Last Name:SAMPAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAYSHREE
Other - Middle Name:HEYMANT
Other - Last Name:SAMPAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 4505
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-4505
Mailing Address - Country:US
Mailing Address - Phone:818-597-3800
Mailing Address - Fax:818-879-8272
Practice Address - Street 1:101 EAST VALENCIA MESA DRIVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835
Practice Address - Country:US
Practice Address - Phone:714-992-3978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC427942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C427940Medicaid
CARHL136179OtherDEPT OF HEALTH
CARHL136179OtherDEPT OF HEALTH
WC42794KMedicare ID - Type Unspecified
CA00C427940Medicaid