Provider Demographics
NPI:1720323348
Name:TAHK, SAMUEL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:TAHK
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 333 BOX 314
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96251-0004
Mailing Address - Country:US
Mailing Address - Phone:310-424-9356
Mailing Address - Fax:
Practice Address - Street 1:549 HC BDAACH UNIT 15245
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:GYEONGGI
Practice Address - Zip Code:96271
Practice Address - Country:KR
Practice Address - Phone:315-737-2019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-07
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA139425208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice