Provider Demographics
NPI:1306891957
Name:SAMI, HANI (MD)
Entity type:Individual
Prefix:
First Name:HANI
Middle Name:
Last Name:SAMI
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 1:147 W SIERRA MADRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2462
Mailing Address - Country:US
Mailing Address - Phone:626-355-3443
Mailing Address - Fax:626-355-7843
Practice Address - Street 1:147 W SIERRA MADRE BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-2462
Practice Address - Country:US
Practice Address - Phone:626-355-3443
Practice Address - Fax:626-355-7843
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0087460Medicaid
G50339Medicare UPIN
CAGR0087460Medicaid