MEDICARE: DR. SAMUEL OSAMU MAYEDA MD

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	174400000X	Specialist	C36879	CA

General Provider Information

NPI Number	:	1487716544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL OSAMU MAYEDA MD

Provider Business Mailing Address
First Line	:	1140 W LA VETA AVE STE 420
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4226
Country	:	US
Telephone Number	:	714-285-1904
Fax Number	:	714-571-5979

Provider Business Practice Location Address
First Line	:	1140 W LA VETA AVE STE 420
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4226
Country	:	US
Telephone Number	:	714-285-1904
Fax Number	:	714-571-5979

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/08/2007

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