Healthcare Provider Details

I. General information

NPI: 1922629112
Provider Name (Legal Business Name): SAMER KEBBEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SAN BERNARDINO RD STE 101
UPLAND CA
91786-4985
US

IV. Provider business mailing address

3770 CANFIELD RD
PASADENA CA
91107-2252
US

V. Phone/Fax

Practice location:
  • Phone: 909-982-2719
  • Fax: 909-946-9931
Mailing address:
  • Phone: 626-535-3521
  • Fax: 909-946-9931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA183194
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA183194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: