Provider Demographics
NPI:1245264910
Name:YASHAR, SHARAM SAMSON (MD)
Entity type:Individual
Prefix:DR
First Name:SHARAM
Middle Name:SAMSON
Last Name:YASHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1850 REDONDO AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-1251
Mailing Address - Country:US
Mailing Address - Phone:562-498-2131
Mailing Address - Fax:562-498-2535
Practice Address - Street 1:1850 REDONDO AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-1251
Practice Address - Country:US
Practice Address - Phone:562-498-2131
Practice Address - Fax:562-498-2535
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA86029207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A860290OtherMEDICAL PPIN #
CAI11241Medicare UPIN
CAWA86029BMedicare ID - Type UnspecifiedPPIN #