Provider Demographics
NPI:1871081455
Name:SANJUM SAMAGH, M.D. INC.
Entity type:Organization
Organization Name:SANJUM SAMAGH, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJUM PAUL
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:SAMAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-799-2083
Mailing Address - Street 1:310 SANTA FE DR STE 112
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5123
Mailing Address - Country:US
Mailing Address - Phone:760-690-3800
Mailing Address - Fax:
Practice Address - Street 1:310 SANTA FE DR STE 112
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5123
Practice Address - Country:US
Practice Address - Phone:760-690-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-29
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128703207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty