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General NPI Number Information
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NPI Number | 1437336435
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Entity Type | Organization
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Legal Business Name | SAMIR AZZAM MD INC
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 1211 W LA PALMA AVE STE 707
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City | ANAHEIM
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State | CA
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Zip | 92801-2814
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Country | US
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Telephone | 714-776-2100
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Fax | 714-776-1960
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Provider Business Mailing Address
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Address Line | 1211 W LA PALMA AVE STE 707
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City | ANAHEIM
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State | CA
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Zip | 92801-2814
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Country | US
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Telephone | 714-776-2100
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Fax | 714-776-1960
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAMIR AZZAM
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Credential | M.D
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Telephone | 714-776-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A51621
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License Number State | CA
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