MEDICARE: EDWARD AHN M.D.

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	174400000X	Specialist	A40196	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	953951355	OTHER	CA	TAX ID #
3	A29073	OTHER	CA	PTAN

General Provider Information

NPI Number	:	1982663795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD AHN M.D.

Provider Business Mailing Address
First Line	:	4620 BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3102
Country	:	US
Telephone Number	:	323-462-6423
Fax Number	:	323-462-3904

Provider Business Practice Location Address
First Line	:	4620 BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3102
Country	:	US
Telephone Number	:	323-462-6423
Fax Number	:	323-462-3904

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	11/06/2007

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Directions to “ EDWARD AHN M.D.” Practice Location

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