Healthcare Provider Details

I. General information

NPI: 1932125580
Provider Name (Legal Business Name): AHN MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 01/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N VERMONT AVE 100
LOS ANGELES CA
90027-6005
US

IV. Provider business mailing address

1300 N VERMONT AVE 100
LOS ANGELES CA
90027-6005
US

V. Phone/Fax

Practice location:
  • Phone: 323-913-4350
  • Fax: 323-913-4351
Mailing address:
  • Phone: 323-457-4350
  • Fax: 323-913-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA45633
License Number StateCA

VIII. Authorized Official

Name: DR. YEONG KUK AHN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 323-457-4350