Provider Demographics
NPI:1053388900
Name:TEYMOURI, SAMAN (MD)
Entity type:Individual
Prefix:
First Name:SAMAN
Middle Name:
Last Name:TEYMOURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PARKCENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-8359
Mailing Address - Country:US
Mailing Address - Phone:916-569-4400
Mailing Address - Fax:916-569-4401
Practice Address - Street 1:2 SCRIPPS DR STE 208
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6207
Practice Address - Country:US
Practice Address - Phone:916-569-4400
Practice Address - Fax:916-569-4435
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56008207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0085030Medicaid
CAGR0085030Medicaid
CAG63750Medicare UPIN