Healthcare Provider Details

I. General information

NPI: 1215890983
Provider Name (Legal Business Name): SAMPLEX A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 SOUTH ST STE 308
LAKEWOOD CA
90712-1518
US

IV. Provider business mailing address

153 SPECKLED ALDER
IRVINE CA
92618-1168
US

V. Phone/Fax

Practice location:
  • Phone: 562-633-2275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMER MOGHADDAM
Title or Position: OWNER/CEO
Credential: MD
Phone: 949-705-8485