Provider Demographics
NPI:1528099470
Name:SAAM, SHIDA (DO)
Entity type:Individual
Prefix:DR
First Name:SHIDA
Middle Name:
Last Name:SAAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16300 SAND CANYON AVE STE 602
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3706
Mailing Address - Country:US
Mailing Address - Phone:949-783-1911
Mailing Address - Fax:
Practice Address - Street 1:16300 SAND CANYON AVE STE 602
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3706
Practice Address - Country:US
Practice Address - Phone:949-783-1911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6743207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX67430Medicaid
CA00AX67430Medicaid