Healthcare Provider Details

I. General information

NPI: 1336108851
Provider Name (Legal Business Name): HYUNG W. AN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 CLARK RD SUITE 5
PARADISE CA
95969-4164
US

IV. Provider business mailing address

PO BOX 4033
PARADISE CA
95967-4033
US

V. Phone/Fax

Practice location:
  • Phone: 530-872-8684
  • Fax: 530-872-8495
Mailing address:
  • Phone: 530-872-8684
  • Fax: 530-872-8495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA64726
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier383688642
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerBLUE CROSS
# 2
Identifier00A647260
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer
# 3
Identifier00A647260
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerBLUE SHIELD
# 4
Identifier383688642
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerTRICARE
# 5
Identifier5492774
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerFIRST HEALTH-CCN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: