Healthcare Provider Details

I. General information

NPI: 1780803080
Provider Name (Legal Business Name): SAMIMI ORTHOPEDIC GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 S ORANGE AVE SUITE 200
WEST COVINA CA
91790-2662
US

IV. Provider business mailing address

PO BOX 1628
WEST COVINA CA
91793-1628
US

V. Phone/Fax

Practice location:
  • Phone: 626-338-7391
  • Fax: 626-814-8308
Mailing address:
  • Phone: 626-338-7391
  • Fax: 626-814-8308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberA043899
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA36076
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA043899
License Number StateCA

VIII. Authorized Official

Name: DR. BABAK SAMIMI
Title or Position: CFO
Credential: MD
Phone: 626-338-7391