MEDICARE: DR. SAMER KANAAN 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	2086S0129X	Vascular Surgery Physician	81611	WI
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	81611	WI
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	A87174	CA

General Provider Information

NPI Number	:	1689864522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMER KANAAN M.D.

Provider Business Mailing Address
First Line	:	4234 RIVERWALK PKWY STE 230
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92505-3312
Country	:	US
Telephone Number	:	951-781-3672
Fax Number	:	951-781-0365

Provider Business Practice Location Address
First Line	:	4234 RIVERWALK PKWY STE 120
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92505-3304
Country	:	US
Telephone Number	:	951-781-3672
Fax Number	:	951-781-0365

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

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	02/23/2024

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