Provider Demographics
NPI:1184731184
Name:NORTH BAY ALLERGY AND ASTHMA
Entity type:Organization
Organization Name:NORTH BAY ALLERGY AND ASTHMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-258-8100
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 LANE
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558
Practice Address - Country:US
Practice Address - Phone:707-258-8100
Practice Address - Fax:707-258-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07211ZOtherMEDICARE (PTAN)
CAGR0092660Medicaid
CAZZZ51160YOtherBLUE SHIELD
CAZZZ06909ZOtherMEDICARE (PTAN)
CAZZZ51159YOtherBLUESHIELD