Provider Demographics
NPI:1265516900
Name:PEJHAM, SAM (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:PEJHAM
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:PO BOX 1319
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368-1319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5565 W LAS POSITAS BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4001
Practice Address - Country:US
Practice Address - Phone:925-460-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69941208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H71325Medicare UPIN