MEDICARE: SAMY FARAG, M.D. MEDICAL GROUP, MC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center	A25821	CA

General Provider Information

NPI Number	:	1245265750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMY FARAG, M.D. MEDICAL GROUP, MC

Provider Business Mailing Address
First Line	:	PO BOX 781
Second Line	:
City	:	LA CANADA
State	:	CA
Zip	:	91012-0781
Country	:	US
Telephone Number	:	323-665-5600
Fax Number	:	323-665-8500

Provider Business Practice Location Address
First Line	:	4430 SANTA MONICA BLVD
Second Line	:	SUITE 101
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2014
Country	:	US
Telephone Number	:	323-665-5600
Fax Number	:	323-665-8500

Authorized Official
Title or Position	:	OWNER
Name	:	SAMY S FARAG
Credential	:	MD
Telephone Number	:	323-665-5600

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/22/2020

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