Provider Demographics
NPI:1952570319
Name:SUMCHAI, AHIMSA P (MD)
Entity type:Individual
Prefix:DR
First Name:AHIMSA
Middle Name:P
Last Name:SUMCHAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AHIMSA
Other - Middle Name:PORTER
Other - Last Name:SUMCHAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:236 W PORTAL AVE # 563
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1423
Mailing Address - Country:US
Mailing Address - Phone:415-859-5471
Mailing Address - Fax:415-952-1174
Practice Address - Street 1:936 ENTERPRISE DRIVE
Practice Address - Street 2:GOLDEN STATE MD HEALTH & WELLNESS
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3916
Practice Address - Country:US
Practice Address - Phone:916-484-1200
Practice Address - Fax:916-484-1211
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48983207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGROO49770Medicaid
CAGROO49770Medicaid