Provider Demographics
NPI:1306894118
Name:JAHANI, SAM (DO)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:JAHANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 CANAL STREET
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77003-1523
Mailing Address - Country:US
Mailing Address - Phone:713-224-0555
Mailing Address - Fax:832-242-9525
Practice Address - Street 1:2502 CANAL STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-1523
Practice Address - Country:US
Practice Address - Phone:713-224-0555
Practice Address - Fax:832-242-9525
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38632207R00000X
TXH4439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06D1050216OtherCLIA
TX133743808Medicaid
CO37332538Medicaid
CO37332538Medicaid
TX257720YKQEMedicare PIN
COC481518Medicare PIN
TX133743808Medicaid