Samuel Dismond III, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

G62220 Issued in CA

Practice address

436 14TH St Ste 1529
Oakland, CA 94612-2703

Phone

(510) 727-5126

Fax

(510) 405-6147

NPI assigned

May 24, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649462400000",
    "number": "1801899570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2238",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954732238",
            "telephone_number": "415-800-7667",
            "fax_number": "831-622-8401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 14TH ST STE 1529",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946122703",
            "telephone_number": "510-727-5126",
            "fax_number": "510-405-6147"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17322 Murphy Ave",
            "address_purpose": "LOCATION",
            "city": "Irvine",
            "state": "CA",
            "postal_code": "926145920",
            "country_code": "US",
            "telephone_number": "510-727-5126",
            "fax_number": "510-405-6147",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1201 J St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958142949",
            "country_code": "US",
            "telephone_number": "510-727-5126",
            "fax_number": "510-405-6147",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DISMOND",
        "first_name": "SAMUEL",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2022-04-09",
        "certification_date": "2022-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "G62220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Oakland, CA
• Providers in Oakland, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2022; 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.