MEDICARE: SOONGJIN AHN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	V9263	TX

General Provider Information

NPI Number	:	1134861370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOONGJIN AHN DO

Provider Business Mailing Address
First Line	:	3600 GASTON AVE STE 651
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1906
Country	:	US
Telephone Number	:	818-531-8512
Fax Number	:	214-820-2530

Provider Business Practice Location Address
First Line	:	3600 GASTON AVE STE 651
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1906
Country	:	US
Telephone Number	:	214-820-3275
Fax Number	:	214-820-2530

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2022
Last Update Date	:	07/23/2025

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Directions to “ SOONGJIN AHN DO” Practice Location

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