Provider Demographics
NPI:1174926190
Name:KHALIFIAN, SAM (MD)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:KHALIFIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SAAMI
Other - Middle Name:
Other - Last Name:KHALIFIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8860 CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7001
Mailing Address - Country:US
Mailing Address - Phone:619-462-1670
Mailing Address - Fax:619-462-3209
Practice Address - Street 1:8860 CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7001
Practice Address - Country:US
Practice Address - Phone:619-462-1670
Practice Address - Fax:619-462-3209
Is Sole Proprietor?:No
Enumeration Date:2014-10-05
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA159219207N00000X, 207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology