Provider Demographics
NPI:1356363543
Name:AHN, ANDREW H (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:H
Last Name:AHN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1900 ROYALTY DR
Mailing Address - Street 2:STE 205
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3013
Mailing Address - Country:US
Mailing Address - Phone:714-530-0303
Mailing Address - Fax:714-530-7703
Practice Address - Street 1:1900 ROYALTY DR
Practice Address - Street 2:STE 205
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3013
Practice Address - Country:US
Practice Address - Phone:714-530-0303
Practice Address - Fax:714-530-7703
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2018-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA370612086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A84959Medicare UPIN
CAA37061Medicare PIN