Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | G149086 | CA |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | G149086 | CA |
N | 207VG0400X | Gynecologist | 209108 | NY |
N | 207VG0400X | Gynecologist | 25MA06718800 | NJ |
NPI | 1831167162 |
---|---|
Provider Name | Sam H. Hessami |
First Address | Colton, CA 92324-1801 |
Second Address | Colton, CA 92324-1801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2006 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7383605 | (05) | NJ |
G149086 | CALIFORNIA MEDICAL LICENSE (01) | CA |
G64108 | (02) |