Healthcare Provider Details

I. General information

NPI: 1043501760
Provider Name (Legal Business Name): SANG HOON AHN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S. VIRGIL AVE SUITE 502
LOS ANGELES CA
90020-1416
US

IV. Provider business mailing address

500 S. VIRGIL AVE SUITE 502
LOS ANGELES CA
90020-1416
US

V. Phone/Fax

Practice location:
  • Phone: 213-388-0908
  • Fax: 213-388-0919
Mailing address:
  • Phone: 213-388-0908
  • Fax: 213-388-0919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA95562
License Number StateCA

VIII. Authorized Official

Name: SANG HOON AHN
Title or Position: PRESIDENT
Credential: MD
Phone: 213-388-0908