Healthcare Provider Details

I. General information

NPI: 1477554335
Provider Name (Legal Business Name): SHAHIN H SAMIMI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 S BRISTOL ST
SANTA ANA CA
92704-6201
US

IV. Provider business mailing address

5700 SOUTHWYCK BLVD
TOLEDO OH
43614-1509
US

V. Phone/Fax

Practice location:
  • Phone: 714-754-5454
  • Fax: 714-979-7284
Mailing address:
  • Phone: 800-288-8325
  • Fax: 419-866-5453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA35793
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: