Provider Demographics
NPI:1992941397
Name:AHDAB, SAM (MD)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:AHDAB
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 1:1433 W MERCED AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3402
Mailing Address - Country:US
Mailing Address - Phone:323-217-2856
Mailing Address - Fax:
Practice Address - Street 1:1433 W MERCED AVE STE 311
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-506-2648
Practice Address - Fax:626-898-9250
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126658207R00000X, 207RH0002X, 208VP0000X
CAA126658208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine