Healthcare Provider Details

I. General information

NPI: 1114148285
Provider Name (Legal Business Name): SAMIR SAIRAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 COLE ST # 289
SAN FRANCISCO CA
94117-4316
US

IV. Provider business mailing address

912 COLE ST #289
SAN FRANCISCO CA
94117-4362
US

V. Phone/Fax

Practice location:
  • Phone: 510-283-9999
  • Fax: 510-751-4551
Mailing address:
  • Phone: 510-283-9999
  • Fax: 510-751-4551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA97890
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA97890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: