Provider Demographics
NPI:1891448874
Name:SAM VAZIRI VANCE INC.
Entity Type:Organization
Organization Name:SAM VAZIRI VANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:310-600-0097
Mailing Address - Street 1:7119 1/2 W SUNSET BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7119 1/2 W SUNSET BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-4411
Practice Address - Country:US
Practice Address - Phone:310-600-0097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPG0041887001OtherBLUE SHIELD