Provider Demographics
NPI:1780785956
Name:LADAN K. SAMADI, M.D. INC.
Entity type:Organization
Organization Name:LADAN K. SAMADI, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LADAN
Authorized Official - Middle Name:KHANDABI
Authorized Official - Last Name:SAMADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-259-9979
Mailing Address - Street 1:PO BOX 55036
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91385-0036
Mailing Address - Country:US
Mailing Address - Phone:661-259-9979
Mailing Address - Fax:661-259-1262
Practice Address - Street 1:27420 TOURNEY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5601
Practice Address - Country:US
Practice Address - Phone:661-259-9979
Practice Address - Fax:661-259-1262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61255207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G83520Medicare UPIN
CAA61255Medicare ID - Type Unspecified