Provider Demographics
NPI:1487230413
Name:KAZAK, SAMARA M (MD)
Entity type:Individual
Prefix:DR
First Name:SAMARA
Middle Name:M
Last Name:KAZAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1040 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-4238
Mailing Address - Country:US
Mailing Address - Phone:805-922-8269
Mailing Address - Fax:805-349-9509
Practice Address - Street 1:1040 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4273
Practice Address - Country:US
Practice Address - Phone:805-922-8269
Practice Address - Fax:805-349-9509
Is Sole Proprietor?:No
Enumeration Date:2021-03-21
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA191387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine