Healthcare Provider Details

I. General information

NPI: 1245264910
Provider Name (Legal Business Name): SHARAM SAMSON YASHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 REDONDO AVE SUITE 108
SIGNAL HILL CA
90755-1251
US

IV. Provider business mailing address

1850 REDONDO AVE SUITE 108
SIGNAL HILL CA
90755-1251
US

V. Phone/Fax

Practice location:
  • Phone: 562-498-2131
  • Fax: 562-498-2535
Mailing address:
  • Phone: 562-498-2131
  • Fax: 562-498-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA86029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: