Provider Demographics
NPI:1306047808
Name:SAMARITAN HEARING AID SPECIALIST
Entity type:Organization
Organization Name:SAMARITAN HEARING AID SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,CEO
Authorized Official - Prefix:
Authorized Official - First Name:AZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DARYAEE SAJJADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-358-8507
Mailing Address - Street 1:2577 SAMARITAN DR STE 845
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4110
Mailing Address - Country:US
Mailing Address - Phone:408-358-8507
Mailing Address - Fax:408-358-8506
Practice Address - Street 1:2577 SAMARITAN DR STE 845
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4110
Practice Address - Country:US
Practice Address - Phone:408-358-8507
Practice Address - Fax:408-358-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA4165332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01333ZMedicare ID - Type Unspecified