Provider Demographics
NPI:1558423814
Name:AHN, SAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:S
Last Name:AHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 PEAR TREE LN
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6446
Mailing Address - Country:US
Mailing Address - Phone:707-258-8100
Mailing Address - Fax:707-258-0734
Practice Address - Street 1:1100 PEAR TREE LN
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6446
Practice Address - Country:US
Practice Address - Phone:707-258-8100
Practice Address - Fax:707-258-0734
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA147289207RA0201X, 207RA0201X
AZ42933207K00000X
CT044285208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA147289OtherCA LICENSE
AZ42933OtherAZ LICENSE
CTBA9771088OtherFED DEA REGISTRATION
NY243190OtherNY LICENSE