Provider Demographics
NPI:1871543942
Name:HAHM, GEOFFREY KENNETH (MD)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:KENNETH
Last Name:HAHM
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 1:3535 SOUTHERN BLVD.
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429
Mailing Address - Country:US
Mailing Address - Phone:937-395-8849
Mailing Address - Fax:937-395-8350
Practice Address - Street 1:3535 SOUTHERN BLVD.
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429
Practice Address - Country:US
Practice Address - Phone:937-395-8849
Practice Address - Fax:937-395-8350
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073158207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2500645Medicaid
OH2500645Medicaid
OHI01882Medicare UPIN
OH4127382Medicare ID - Type Unspecified