Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E5404 | CA |
N | 213ES0103X | Foot & Ankle Surgery | EL6732 | CA |
NPI | 1023565165 |
---|---|
Provider Name | Dr. Pegah Samouhi |
First Address | Encino, CA 91436-1990 |
Second Address | Los Angeles, CA 90048-5901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2016 |
Last Update Date | 02/11/2021 |