Provider Demographics
NPI:1568581759
Name:AHN, SANG HOON (MD)
Entity Type:Individual
Prefix:
First Name:SANG
Middle Name:HOON
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:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:213-388-0908
Mailing Address - Fax:213-388-0919
Practice Address - Street 1:500 S VIRGIL AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1446
Practice Address - Country:US
Practice Address - Phone:213-388-0908
Practice Address - Fax:213-388-0919
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95562174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A955620Medicaid
CA00A955620Medicaid