Provider Demographics
NPI:1992245971
Name:AHN, SOO (PHARMD)
Entity type:Individual
Prefix:
First Name:SOO
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:YOUNG SOO
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD,
Mailing Address - Street 1:2060 TAPO ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3417
Mailing Address - Country:US
Mailing Address - Phone:310-972-1110
Mailing Address - Fax:
Practice Address - Street 1:2060 TAPO ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3417
Practice Address - Country:US
Practice Address - Phone:805-522-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490691835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care