Provider Demographics
NPI:1396881207
Name:SAMEH ELSANADI MD,INC.
Entity type:Organization
Organization Name:SAMEH ELSANADI MD,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMEH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELSANADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-581-0881
Mailing Address - Street 1:9070 IRVINE CENTER DR
Mailing Address - Street 2:SUITE# 105
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4678
Mailing Address - Country:US
Mailing Address - Phone:949-581-0881
Mailing Address - Fax:949-581-0911
Practice Address - Street 1:9070 IRVINE CENTER DR
Practice Address - Street 2:SUITE# 105
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4678
Practice Address - Country:US
Practice Address - Phone:949-581-0881
Practice Address - Fax:949-581-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14114Medicare ID - Type Unspecified