Basic Information
| Provider Information | |||||||||
| NPI: | 1942521174 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VON INS | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | MEKHAIL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15090 | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928035090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145772124 | ||||||||
| FaxNumber: | 7145772125 | ||||||||
| Practice Location | |||||||||
| Address1: | 1041 E YORBA LINDA BLVD STE 306 | ||||||||
| Address2: | |||||||||
| City: | PLACENTIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928703751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145779500 | ||||||||
| FaxNumber: | 7145779504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2010 | ||||||||
| LastUpdateDate: | 04/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | A117579 | CA | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | FV2732495 | 01 | CA | DEA | OTHER | FV3928352 | 01 | CA | DEA | OTHER |