Provider Demographics
NPI:1457126757
Name:AHN, SEUNGHO FOREST MEDICAL
Entity Type:Individual
Prefix:
First Name:SEUNGHO
Middle Name:FOREST MEDICAL
Last Name:AHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22762 ASPAN ST STE 209
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1604
Mailing Address - Country:US
Mailing Address - Phone:949-588-6767
Mailing Address - Fax:949-588-6834
Practice Address - Street 1:22762 ASPAN ST STE 209
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1604
Practice Address - Country:US
Practice Address - Phone:949-588-6767
Practice Address - Fax:949-588-6834
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
CAAC6306171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist