Provider Demographics
NPI:1295889202
Name:FAYEK, SAMEH (MD)
Entity type:Individual
Prefix:
First Name:SAMEH
Middle Name:
Last Name:FAYEK
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 1:6504 PARK LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-2307
Mailing Address - Country:US
Mailing Address - Phone:443-986-1649
Mailing Address - Fax:
Practice Address - Street 1:25550 HAWTHORNE BLVD STE 209
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6832
Practice Address - Country:US
Practice Address - Phone:310-400-0645
Practice Address - Fax:424-270-6232
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0067999204F00000X
TXQ4097204F00000X
PAMD428478208600000X
CAA83958208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350261907Medicaid
TX441389YSE6Medicare PIN