Provider Demographics
NPI:1801855028
Name:BOUN, SINGH AHN (MD)
Entity type:Individual
Prefix:
First Name:SINGH
Middle Name:AHN
Last Name:BOUN
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 1:511 W NEWBY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3413
Mailing Address - Country:US
Mailing Address - Phone:626-374-7029
Mailing Address - Fax:
Practice Address - Street 1:210 N GARFIELD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1746
Practice Address - Country:US
Practice Address - Phone:626-280-5000
Practice Address - Fax:626-280-5100
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A796580Medicaid
CA00A796581Medicaid
CA00A796580Medicaid
CA00A796581Medicaid