Sam Shiesha, MD, FAAFP

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

A46051 Issued in CA

Practice address

25101 Bear Valley Rd
PMB 347
Tehachapi, CA 93561-8311

Phone

(661) 335-2891

NPI assigned

Sep 21, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319068800000",
    "number": "1316046253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25101 BEAR VALLEY RD",
            "address_2": "PMB 347",
            "city": "TEHACHAPI",
            "state": "CA",
            "postal_code": "935618311",
            "telephone_number": "661-335-2891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25101 BEAR VALLEY RD",
            "address_2": "PMB 347",
            "city": "TEHACHAPI",
            "state": "CA",
            "postal_code": "935618311",
            "telephone_number": "661-335-2891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIESHA",
        "first_name": "SAM",
        "name_prefix": "Dr.",
        "credential": "MD,  FAAFP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2011-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0000X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": "CA",
            "license": "A46051",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CA",
            "license": "A46051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A460510",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Medicine Physician in Tehachapi, CA
• Providers in Tehachapi, CA by specialty
• Adult Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.