Provider Demographics
NPI:1194715193
Name:AHN, BYUNG DON (MD)
Entity type:Individual
Prefix:
First Name:BYUNG
Middle Name:DON
Last Name:AHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1382 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4014
Mailing Address - Country:US
Mailing Address - Phone:909-982-6500
Mailing Address - Fax:909-920-0406
Practice Address - Street 1:1382 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4014
Practice Address - Country:US
Practice Address - Phone:909-982-6500
Practice Address - Fax:909-920-0406
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2013-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA39266207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A392661Medicare PIN
A28854Medicare UPIN