Provider Demographics
NPI:1205151032
Name:KASSAR, SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:KASSAR
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 1:315 E ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6244
Mailing Address - Country:US
Mailing Address - Phone:626-963-4124
Mailing Address - Fax:626-335-8714
Practice Address - Street 1:315 E ROUTE 66
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6244
Practice Address - Country:US
Practice Address - Phone:626-963-4124
Practice Address - Fax:626-335-8714
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA130965207V00000X, 193400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes193400000XGroupSingle Specialty
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology