Provider Demographics
NPI:1134861370
Name:AHN, SOONGJIN (DO)
Entity type:Individual
Prefix:
First Name:SOONGJIN
Middle Name:
Last Name:AHN
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE STE 651
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1906
Mailing Address - Country:US
Mailing Address - Phone:818-531-8512
Mailing Address - Fax:214-820-2530
Practice Address - Street 1:3600 GASTON AVE STE 651
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1906
Practice Address - Country:US
Practice Address - Phone:214-820-3275
Practice Address - Fax:214-820-2530
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program