Healthcare Provider Details

I. General information

NPI: 1922369818
Provider Name (Legal Business Name): AHN BASSUK CALIFORNIA HOSPITALISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WILSON TER
GLENDALE CA
91206-4007
US

IV. Provider business mailing address

PO BOX 10160
GLENDALE CA
91209-3160
US

V. Phone/Fax

Practice location:
  • Phone: 818-795-2460
  • Fax: 818-356-4465
Mailing address:
  • Phone: 818-795-2460
  • Fax: 818-356-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: EUGENE YUJIN AHN
Title or Position: PRESIDENT
Credential: MD
Phone: 818-795-2460