Provider Demographics
NPI:1184818338
Name:K D AHN MD
Entity Type:Organization
Organization Name:K D AHN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VENEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-620-0389
Mailing Address - Street 1:1900 ROYALTY DR STE 205
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3013
Mailing Address - Country:US
Mailing Address - Phone:909-620-0389
Mailing Address - Fax:909-623-3911
Practice Address - Street 1:1900 ROYALTY DR
Practice Address - Street 2:STE 205
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767
Practice Address - Country:US
Practice Address - Phone:909-620-0389
Practice Address - Fax:909-623-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A352990Medicaid
CA00A352990Medicaid
CAA27737Medicare UPIN