Provider Demographics
NPI:1932344058
Name:ALSAMMAN, HUSAM (MD, FCCP)
Entity Type:Individual
Prefix:
First Name:HUSAM
Middle Name:
Last Name:ALSAMMAN
Suffix:
Gender:M
Credentials:MD, FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3943 IRVINE BLVD # 35
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2400
Mailing Address - Country:US
Mailing Address - Phone:949-468-0849
Mailing Address - Fax:810-222-6854
Practice Address - Street 1:3943 IRVINE BLVD # 35
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-2400
Practice Address - Country:US
Practice Address - Phone:949-468-0849
Practice Address - Fax:810-222-6854
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054216207L00000X
OH65557207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0938589Medicaid
CAF68141Medicare UPIN