MEDICARE: SANG SUNG AHN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080N0001X	Neonatal-Perinatal Medicine Physician	5481	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457451320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANG SUNG AHN M.D.

Provider Business Mailing Address
First Line	:	5586 S FORT APACHE RD
Second Line	:	STE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-3619
Country	:	US
Telephone Number	:	702-384-8099
Fax Number	:	702-384-3930

Provider Business Practice Location Address
First Line	:	5586 S FORT APACHE RD
Second Line	:	STE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-3619
Country	:	US
Telephone Number	:	702-384-8099
Fax Number	:	702-384-3930

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/09/2007

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