Healthcare Provider Details

I. General information

NPI: 1043748023
Provider Name (Legal Business Name): DARYOOSH SAMIMI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 06/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17150 EUCLID ST STE 220
FOUNTAIN VALLEY CA
92708-4092
US

IV. Provider business mailing address

PO BOX 9870
FOUNTAIN VALLEY CA
92728-9870
US

V. Phone/Fax

Practice location:
  • Phone: 714-546-3898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA34931
License Number StateCA

VIII. Authorized Official

Name: DR. DARYOOSH SAMIMI
Title or Position: PRESIDENT
Credential: MD
Phone: 714-374-0816