Provider Demographics
NPI:1326112913
Name:HANNA, SAMEH R (MD)
Entity type:Individual
Prefix:DR
First Name:SAMEH
Middle Name:R
Last Name:HANNA
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 1:3400 DATA DR
Mailing Address - Street 2:ATTENTION: CREDENTIALING AND PAYER ENROLLMENT DEPT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 E HIGHLAND AVE STE 251
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3800
Practice Address - Country:US
Practice Address - Phone:909-864-4700
Practice Address - Fax:909-383-4009
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC168064207RC0200X
CA168064207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576000003OtherBLUE CROSS BLUE SHIELD SC
SC278773Medicaid
SC576000003OtherBLUE CROSS BLUE SHIELD SC
SC143278Medicare UPIN