MEDICARE: EUGENE S AHN MD

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	2085R0001X	Radiation Oncology Physician	A71690	CA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912999533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE S AHN MD

Provider Business Mailing Address
First Line	:	2900 LOMA VISTA RD STE 100
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93003-2909
Country	:	US
Telephone Number	:	805-648-5191
Fax Number	:	805-648-3458

Provider Business Practice Location Address
First Line	:	2985 SYCAMORE DR
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-1201
Country	:	US
Telephone Number	:	805-584-6611
Fax Number	:	805-584-0530

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	08/05/2022

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