Provider Demographics
NPI:1386664233
Name:SAMAAN, ADEL FAHMY (MD)
Entity type:Individual
Prefix:DR
First Name:ADEL
Middle Name:FAHMY
Last Name:SAMAAN
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 1:2118 WILSHIRE BLVD
Mailing Address - Street 2:STE 1002
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5704
Mailing Address - Country:US
Mailing Address - Phone:310-914-0130
Mailing Address - Fax:
Practice Address - Street 1:2118 WILSHIRE BLVD
Practice Address - Street 2:STE 1002
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5704
Practice Address - Country:US
Practice Address - Phone:310-914-0130
Practice Address - Fax:818-907-6157
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38660208D00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A38660OtherMEDI-CAL
CA2275017Medicaid
CAA38660Medicare PIN
CA00A38660OtherMEDI-CAL