Provider Demographics
NPI:1356450498
Name:AHN, ELIZA SUKHEE (MD)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:SUKHEE
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 1:15243 VANOWEN ST STE 311
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3653
Mailing Address - Country:US
Mailing Address - Phone:747-800-7454
Mailing Address - Fax:747-264-0433
Practice Address - Street 1:15243 VANOWEN ST STE 311
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3653
Practice Address - Country:US
Practice Address - Phone:747-800-7454
Practice Address - Fax:747-264-0433
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77767207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG77767DMedicare ID - Type Unspecified