Provider Demographics
NPI:1073504031
Name:AHN, YEONG K (MD)
Entity Type:Individual
Prefix:DR
First Name:YEONG
Middle Name:K
Last Name:AHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N VERMONT AVE
Mailing Address - Street 2:# 600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6098
Mailing Address - Country:US
Mailing Address - Phone:213-457-4350
Mailing Address - Fax:213-913-4351
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6005
Practice Address - Country:US
Practice Address - Phone:323-457-4350
Practice Address - Fax:323-913-4351
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45633174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A456330Medicaid
CA00A456330Medicaid
CAA45633Medicare ID - Type Unspecified