MEDICARE: MR. SADEGH SAMAD POURIE JAVID

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	246Q00000X	Pathology Specialist/Technologist	MTA-02340625	CA

General Provider Information

NPI Number	:	1265367536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SADEGH SAMAD POURIE JAVID

Provider Business Mailing Address
First Line	:	12307 PINTADO
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-0276
Country	:	US
Telephone Number	:	310-862-0813
Fax Number	:

Provider Business Practice Location Address
First Line	:	12307 PINTADO
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-0276
Country	:	US
Telephone Number	:	310-862-0813
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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