MEDICARE: SAM SEUNGHAE AHN MD

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	2086S0129X	Vascular Surgery Physician	F1333	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00429299	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	208087232	OTHER	TX	TRICARE/CHAMPUS
4	8AD481	OTHER	TX	BLUE CROSS PPO

General Provider Information

NPI Number	:	1497783831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAM SEUNGHAE AHN MD

Provider Business Mailing Address
First Line	:	1082 GLENDON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-2908
Country	:	US
Telephone Number	:	310-209-2011
Fax Number	:	310-209-2113

Provider Business Practice Location Address
First Line	:	1082 GLENDON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-2908
Country	:	US
Telephone Number	:	310-209-2011
Fax Number	:	310-209-2113

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	08/14/2025

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Directions to “ SAM SEUNGHAE AHN MD” Practice Location

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