Provider Demographics
NPI:1316332166
Name:BHAKTA, SAMIR S (MD)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:S
Last Name:BHAKTA
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 1:388 E OCEAN BLVD UNIT 1505
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-5275
Mailing Address - Country:US
Mailing Address - Phone:316-519-5982
Mailing Address - Fax:
Practice Address - Street 1:388 E OCEAN BLVD UNIT 1505
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-5275
Practice Address - Country:US
Practice Address - Phone:316-519-5982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA162556332B00000X, 207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program