Basic Information
| Provider Information | |||||||||
| NPI: | 1548434293 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAM SANANDAJI, DPM, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16952 VENTURA BLVD | ||||||||
| Address2: | SUITE # 100 | ||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913164197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187893964 | ||||||||
| FaxNumber: | 8187893967 | ||||||||
| Practice Location | |||||||||
| Address1: | 16952 VENTURA BLVD | ||||||||
| Address2: | SUITE # 100 | ||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913164197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187893964 | ||||||||
| FaxNumber: | 8187893967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2008 | ||||||||
| LastUpdateDate: | 04/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | SANANDAJI | ||||||||
| AuthorizedOfficialFirstName: | SAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8186934790 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | E4652 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.