Healthcare Provider Details

I. General information

NPI: 1568581759
Provider Name (Legal Business Name): SANG HOON AHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 11/27/2023
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S VIRGIL AVE SUITE 502
LOS ANGELES CA
90020-1446
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
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 TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA95562
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA95562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: