Provider Demographics
NPI:1942318373
Name:AHN, DUKE (MD)
Entity Type:Individual
Prefix:DR
First Name:DUKE
Middle Name:
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 1:1040 ELM AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3264
Mailing Address - Country:US
Mailing Address - Phone:562-591-4444
Mailing Address - Fax:562-436-7350
Practice Address - Street 1:3700 KATELLA AVE STE C
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6409
Practice Address - Country:US
Practice Address - Phone:562-583-2250
Practice Address - Fax:562-583-2254
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84554207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG084554OtherLICENSE
CA00G845540Medicaid
CA0226020002Medicare NSC
CAWG84554BMedicare PIN
CA00G845540Medicaid
CAWG84554AMedicare PIN