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General NPI Number Information
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NPI Number | 1720323348
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Entity Type | Individual
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Provider Name | SAMUEL TAHK M.D., PH.D
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Gender | Male
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Dates
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Enumeration Date | 12/07/2012
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 549 HC BDAACH UNIT 15245
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City | APO
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State | GYEONGGI
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Zip | 96271
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Country | KR
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Telephone | 315-737-2019
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Fax |
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Provider Business Mailing Address
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Address Line | BLDG 390 N. LOOP ROAD
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City | FORT IRWIN
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State | CA
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Zip | 92310
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Country | US
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Telephone | 866-957-9224
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A139425
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License Number State | CA
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