Healthcare Provider Details

I. General information

NPI: 1346685260
Provider Name (Legal Business Name): MARK Y SAH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK BLVD
BRISTOL TN
37620
US

IV. Provider business mailing address

509 MED TECH PKWY STE 1
JOHNSON CITY TN
37604-2578
US

V. Phone/Fax

Practice location:
  • Phone: 423-844-5560
  • Fax: 423-844-5569
Mailing address:
  • Phone: 423-952-2111
  • Fax: 423-952-2175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3400
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number3400
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: