Provider Demographics
NPI:1740376433
Name:FINK, SAMUEL IRA (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:IRA
Last Name:FINK
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 1:5620 WILBUR AVENUE
Mailing Address - Street 2:SUITE 333
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1311
Mailing Address - Country:US
Mailing Address - Phone:818-609-0700
Mailing Address - Fax:818-705-3954
Practice Address - Street 1:5620 WILBUR AVENUE
Practice Address - Street 2:SUITE 333
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1311
Practice Address - Country:US
Practice Address - Phone:818-609-0700
Practice Address - Fax:818-705-3954
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85719Medicare UPIN
CAW18312Medicare ID - Type UnspecifiedMEDICARE I.D. NUMBER