Provider Demographics
NPI:1083020820
Name:AHN, SE JIN (MD)
Entity Type:Individual
Prefix:
First Name:SE JIN
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD SUITE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-8707
Mailing Address - Fax:310-301-8751
Practice Address - Street 1:757 WESTWOOD PLZ STE 1638
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-5201
Practice Address - Country:US
Practice Address - Phone:310-267-8796
Practice Address - Fax:310-267-2059
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1594142085R0202X
MDP30309282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No282N00000XHospitalsGeneral Acute Care Hospital