Basic Information
| Provider Information | |||||||||
| NPI: | 1386664233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMAAN | ||||||||
| FirstName: | ADEL | ||||||||
| MiddleName: | FAHMY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2118 WILSHIRE BLVD | ||||||||
| Address2: | STE 1002 | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904035704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109140130 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2118 WILSHIRE BLVD | ||||||||
| Address2: | STE 1002 | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904035704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109140130 | ||||||||
| FaxNumber: | 8189076157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 05/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | A38660 | CA | N | Allopathic & Osteopathic Physicians | General Practice | 207V00000X | A38660 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00A38660 | 01 | CA | MEDI-CAL | OTHER | 2275017 | 05 | CA | MEDICAID |