Provider Demographics
NPI:1306252929
Name:AHN, SARAH PARK (DPM)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:PARK
Last Name:AHN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:4611 E SHEA BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4257
Mailing Address - Country:US
Mailing Address - Phone:415-984-2700
Mailing Address - Fax:415-984-9920
Practice Address - Street 1:4611 E SHEA BLVD STE 160
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028
Practice Address - Country:US
Practice Address - Phone:480-705-9920
Practice Address - Fax:888-872-0466
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5336213E00000X
282N00000X
AZPOD-000914213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ522162Medicaid