Healthcare Provider Details

I. General information

NPI: 1790794873
Provider Name (Legal Business Name): RAMIN SAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2006
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVENUE WARD 17 DIALYSIS CLINIC, BLDG. 100, 3RD FL.
SAN FRANCISCO CA
94110-3510
US

IV. Provider business mailing address

1001 POTRERO AVE. WARD 17 DIALYSIS CLINIC, BLDG. 100, 3RD FL.
SAN FRANCISCO CA
94110-3510
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8242
  • Fax: 415-285-2389
Mailing address:
  • Phone: 628-206-8242
  • Fax: 415-285-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA102519
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA102519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: