MEDICARE: SAMUEL T 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	2085R0202X	Diagnostic Radiology Physician	MD21108	HI
2	2085R0202X	Diagnostic Radiology Physician	30434	CO
3	2085R0204X	Vascular & Interventional Radiology Physician	30434	CO
4	2085R0202X	Diagnostic Radiology Physician	27274	NE
5	2085R0202X	Diagnostic Radiology Physician	04-43282	KS

General Provider Information

NPI Number	:	1942286661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL T AHN MD

Provider Business Mailing Address
First Line	:	9961 SIERRA AVE
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92335-6720
Country	:	US
Telephone Number	:	909-427-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	9961 SIERRA AVE
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92335-6720
Country	:	US
Telephone Number	:	909-427-5000
Fax Number	:

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	05/08/2026

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