Provider Demographics
NPI:1356596233
Name:SAMVATIAN, SOHEIL (MD)
Entity type:Individual
Prefix:
First Name:SOHEIL
Middle Name:
Last Name:SAMVATIAN
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 1:24799 ALICIA PKWY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4618
Mailing Address - Country:US
Mailing Address - Phone:949-652-2515
Mailing Address - Fax:661-520-4050
Practice Address - Street 1:24799 ALICIA PKWY
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4618
Practice Address - Country:US
Practice Address - Phone:949-652-2515
Practice Address - Fax:661-520-4050
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105183207QA0505X, 261QP2300X, 261QU0200X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care