Provider Demographics
NPI:1336197409
Name:SAMADI, FARZIN (MD)
Entity Type:Individual
Prefix:
First Name:FARZIN
Middle Name:
Last Name:SAMADI
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 241424
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024
Mailing Address - Country:US
Mailing Address - Phone:310-659-8080
Mailing Address - Fax:310-659-9085
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:STE 540 EAST
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-659-8080
Practice Address - Fax:310-659-9085
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A660950OtherBS OF CA
CA00A660950Medicaid
CAWA66095DMedicare ID - Type Unspecified
CA00A660950OtherBS OF CA