Healthcare Provider Details

I. General information

NPI: 1346824786
Provider Name (Legal Business Name): SABRINA AHN VAA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 06/25/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 X STREET C/O PEDIATRIC ICU
SACRAMENTO CA
95817-2350
US

IV. Provider business mailing address

4301 X STREET C/O PEDIATRIC ICU
SACRAMENTO CA
95817-2350
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2994
  • Fax: 916-734-0960
Mailing address:
  • Phone: 916-734-2994
  • Fax: 916-734-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number95013298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: