Healthcare Provider Details

I. General information

NPI: 1407484918
Provider Name (Legal Business Name): SETH AUSTIN AHLQUIST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 SANTA MONICA BLVD # 530E
SANTA MONICA CA
90404-2208
US

IV. Provider business mailing address

2021 SANTA MONICA BLVD STE 530E
SANTA MONICA CA
90404-2208
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-2042
  • Fax:
Mailing address:
  • Phone: 310-828-2042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberA185370
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA185370
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: