Healthcare Provider Details

I. General information

NPI: 1962978114
Provider Name (Legal Business Name): SAMER MOGHADDAM MD, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 N GRAND AVE STE 201
SANTA ANA CA
92701-4218
US

IV. Provider business mailing address

17595 HARVARD AVE STE C146
IRVINE CA
92614-8516
US

V. Phone/Fax

Practice location:
  • Phone: 657-212-5177
  • Fax: 949-502-8887
Mailing address:
  • Phone: 949-705-8485
  • Fax: 949-502-8887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

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