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General NPI Number Information
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NPI Number | 1821364084
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Entity Type | Individual
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Provider Name | SAM CHITSAZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2012
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 4053 LONE TREE WAY STE 200
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City | ANTIOCH
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State | CA
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Zip | 94531-6210
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Country | US
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Telephone | 925-776-7725
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Fax | 510-506-7728
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Provider Business Mailing Address
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Address Line | 4053 LONE TREE WAY STE 200
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City | ANTIOCH
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State | CA
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Zip | 94531-6210
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Country | US
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Telephone | 925-776-7725
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Fax | 510-506-7728
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A153515
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | R6761
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License Number State | TX
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