Healthcare Provider Details

I. General information

NPI: 1932150182
Provider Name (Legal Business Name): SAM SEUNGHAE AHN, MD,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W COLORADO BLVD SUITE 625
DALLAS TX
75208-2363
US

IV. Provider business mailing address

221 W COLORADO BLVD SUITE 625
DALLAS TX
75208-2363
US

V. Phone/Fax

Practice location:
  • Phone: 214-946-5165
  • Fax: 214-946-4876
Mailing address:
  • Phone: 214-946-5165
  • Fax: 214-946-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberF1333
License Number StateTX

VIII. Authorized Official

Name: SAM SEUNGHAE AHN
Title or Position: OWNER
Credential: MD
Phone: 214-946-5165