Provider Demographics
NPI:1649342171
Name:AHN, MARTIN TAEHUNG (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:TAEHUNG
Last Name:AHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6301 BEACH BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2840
Mailing Address - Country:US
Mailing Address - Phone:714-525-9900
Mailing Address - Fax:714-880-3180
Practice Address - Street 1:6301 BEACH BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621
Practice Address - Country:US
Practice Address - Phone:714-525-9900
Practice Address - Fax:714-880-3180
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2018-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA85576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0099930Medicaid
CAI16672Medicare UPIN
CAW18427Medicare ID - Type Unspecified