Provider Demographics
NPI:1013271147
Name:KANNO, SAMER SAMI HANNA (MD)
Entity Type:Individual
Prefix:
First Name:SAMER
Middle Name:SAMI HANNA
Last Name:KANNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAMER
Other - Middle Name:
Other - Last Name:KANNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 231189
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92023-1189
Mailing Address - Country:US
Mailing Address - Phone:760-230-2251
Mailing Address - Fax:
Practice Address - Street 1:354 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5142
Practice Address - Country:US
Practice Address - Phone:760-230-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301100339390200000X
CAA137914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB254429Medicare PIN