MEDICARE: SAM ZIJOUDI

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	122300000X	Dentist	105896	CA

General Provider Information

NPI Number	:	1902493182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAM ZIJOUDI

Provider Business Mailing Address
First Line	:	1601 PRECISION PARK LN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92173-1345
Country	:	US
Telephone Number	:	619-662-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	5807 UNIVERSITY AVE STE 3
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-6295
Country	:	US
Telephone Number	:	619-610-1134
Fax Number	:

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

Provider Enumeration Date	:	12/22/2020
Last Update Date	:	03/12/2026

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Directions to “ SAM ZIJOUDI ” Practice Location

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