Provider Demographics
NPI:1912999533
Name:AHN, EUGENE S (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:S
Last Name:AHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2900 LOMA VISTA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2909
Mailing Address - Country:US
Mailing Address - Phone:805-648-5191
Mailing Address - Fax:805-648-3458
Practice Address - Street 1:2985 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1201
Practice Address - Country:US
Practice Address - Phone:805-584-6611
Practice Address - Fax:805-584-0530
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA716902085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912999533Medicaid
CA00A716900Medicaid