Healthcare Provider Details

I. General information

NPI: 1770042004
Provider Name (Legal Business Name): SAMUEL HYRUM BARLOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2019
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 SAND CANYON AVE STE 245
IRVINE CA
92618-3744
US

IV. Provider business mailing address

19582 BEACH BLVD STE 325
HUNTINGTON BEACH CA
92648-5923
US

V. Phone/Fax

Practice location:
  • Phone: 949-557-0380
  • Fax: 949-557-0381
Mailing address:
  • Phone: 714-477-8020
  • Fax: 714-477-8072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA179511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: