Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 147289 | CA |
NPI | 1558423814 |
---|---|
Provider Name | Dr. Sam S Ahn |
First Address | Napa, CA 94558-6446 |
Second Address | Napa, CA 94558-6446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 05/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
147289 | CA LICENSE (01) | CA |
42933 | AZ LICENSE (01) | AZ |
BA9771088 | FED DEA REGISTRATION (01) | CT |