Healthcare Provider Details

I. General information

NPI: 1578268124
Provider Name (Legal Business Name): SAMI IRAJ DAHER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WILSON TER
GLENDALE CA
91206-4007
US

IV. Provider business mailing address

2950 SYCAMORE DR STE 300
SIMI VALLEY CA
93065-1210
US

V. Phone/Fax

Practice location:
  • Phone: 818-409-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: