Provider Demographics
NPI:1992231112
Name:SAMER KANAAN MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SAMER KANAAN MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:LINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANAAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-910-8058
Mailing Address - Street 1:30732 PASEO ELEGANCIA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-5426
Mailing Address - Country:US
Mailing Address - Phone:269-910-8059
Mailing Address - Fax:
Practice Address - Street 1:27451 LOS ALTOS, SUITE 290
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-444-5864
Practice Address - Fax:949-258-5863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87174208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty