Provider Demographics
NPI:1174602163
Name:SAYYUR, LUTFI A (MD)
Entity type:Individual
Prefix:
First Name:LUTFI
Middle Name:A
Last Name:SAYYUR
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 1:3943 IRVINE BLVD # 407
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2400
Mailing Address - Country:US
Mailing Address - Phone:714-651-8138
Mailing Address - Fax:816-892-5981
Practice Address - Street 1:101 E VALENCIA MESA DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3809
Practice Address - Country:US
Practice Address - Phone:714-871-3280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50181207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0014371OtherMEDI-CAL PROV
CAZZZ97067ZOtherBLUE SHIELD
CA290011546OtherRAILROAD MEDICARE
CAC50181OtherSTATE LICENSE
CAGR0014371OtherMEDI-CAL PROV
CAZZZ97067ZOtherBLUE SHIELD