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NPI Code Detail

MEDICARE: DR. SAM NIRUYI DDS

MEDICARE: DR. SAM NIRUYI DDS
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
1122300000XDentist56796CA

General Provider Information

NPI Number : 1295819464
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SAM NIRUYI DDS
Provider Business Mailing Address
First Line : 808 W 58TH ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90037-3632
Country : US
Telephone Number : 323-541-1600
Fax Number : 323-541-1411
Provider Business Practice Location Address
First Line : 808 W 58TH ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90037-3632
Country : US
Telephone Number : 323-541-1600
Fax Number : 323-541-1411
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 09/24/2015

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