Provider Demographics
NPI:1982147609
Name:AHN, TONY J (DPT)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:J
Last Name:AHN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 WILSHIRE BLVD APT 1704
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3228
Mailing Address - Country:US
Mailing Address - Phone:213-598-9593
Mailing Address - Fax:
Practice Address - Street 1:3810 WILSHIRE BLVD APT 1704
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3228
Practice Address - Country:US
Practice Address - Phone:213-598-9593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist