Provider Demographics
NPI:1285605212
Name:EJADI, SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:EJADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 THE CITY DR S BLDG. 56 RM. 240
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3201
Mailing Address - Country:US
Mailing Address - Phone:714-456-8000
Mailing Address - Fax:714-456-7142
Practice Address - Street 1:101 THE CITY DR S RM 240
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-8000
Practice Address - Fax:714-456-2242
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228707207RX0202X
AZ36682207RX0202X
NJ25MA07608600207RX0202X
CAC55259207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00413300OtherRAILROAD MEDICARE
AZ231941Medicaid
AZZ116663Medicare PIN
AZP00413300OtherRAILROAD MEDICARE
H90783Medicare UPIN