MEDICARE: DR. DIBA K SAMENI M.D.

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	2084P0800X	Psychiatry Physician	A90861	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A908610	OTHER	CA	MEDICAL PPIN #

General Provider Information

NPI Number	:	1306887351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIBA K SAMENI M.D.

Provider Business Mailing Address
First Line	:	393 E WALNUT ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91188-0001
Country	:	US
Telephone Number	:	888-505-0043
Fax Number	:

Provider Business Practice Location Address
First Line	:	393 E WALNUT ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91188-0001
Country	:	US
Telephone Number	:	888-505-0043
Fax Number	:

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	12/21/2021

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