Healthcare Provider Details

I. General information

NPI: 1821364084
Provider Name (Legal Business Name): SAM CHITSAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2012
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4053 LONE TREE WAY STE 200
ANTIOCH CA
94531-6210
US

IV. Provider business mailing address

4053 LONE TREE WAY STE 200
ANTIOCH CA
94531-6210
US

V. Phone/Fax

Practice location:
  • Phone: 925-776-7725
  • Fax: 510-506-7728
Mailing address:
  • Phone: 925-776-7725
  • Fax: 510-506-7728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA153515
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberR6761
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: