Provider Demographics
NPI:1326217266
Name:DR. SAM JAHANI D.O.
Entity Type:Organization
Organization Name:DR. SAM JAHANI D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JAHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-874-9977
Mailing Address - Street 1:164 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-1842
Mailing Address - Country:US
Mailing Address - Phone:970-874-9977
Mailing Address - Fax:970-874-9952
Practice Address - Street 1:164 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-1842
Practice Address - Country:US
Practice Address - Phone:970-874-9977
Practice Address - Fax:970-874-9952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38632174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty