Provider Demographics
NPI:1699779231
Name:AHN, HONG GOO (MD)
Entity type:Individual
Prefix:
First Name:HONG
Middle Name:GOO
Last Name:AHN
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 1:17507 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-3403
Mailing Address - Country:US
Mailing Address - Phone:310-324-4443
Mailing Address - Fax:310-324-7925
Practice Address - Street 1:17507 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-3403
Practice Address - Country:US
Practice Address - Phone:310-324-4443
Practice Address - Fax:310-324-7925
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33170174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A331700Medicaid
A84442Medicare UPIN
CA00A331700Medicaid