Provider Demographics
NPI:1346211877
Name:AHN, SUNGKEE SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNGKEE
Middle Name:SAMUEL
Last Name:AHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10373A REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3617
Mailing Address - Country:US
Mailing Address - Phone:410-356-8186
Mailing Address - Fax:410-356-4180
Practice Address - Street 1:21 CROSSROADS DR
Practice Address - Street 2:STE 100
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5441
Practice Address - Country:US
Practice Address - Phone:410-356-8186
Practice Address - Fax:410-356-4180
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00433022085R0202X, 2085N0700X, 207R00000X
NY2704162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD180941500Medicaid
DC0019OtherBC BS 2849
DE1000038547Medicaid
MDKA80OtherB/C B/S
MD0002OtherBC BS J062
MD435L153CMedicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 02
DE00B665A20Medicare ID - Type UnspecifiedLOCALITY/JURIS. 02 DC/DE
DC0019OtherBC BS 2849
DE1000038547Medicaid
MD0002OtherBC BS J062
MD434L105CMedicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 01
MDKA80OtherB/C B/S