Individual
SAM SEUNGHAE AHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1082 GLENDON AVE, LOS ANGELES, CA 90024-2908
(310) 209-2011
(310) 209-2113
Mailing address
1082 GLENDON AVE, LOS ANGELES, CA 90024-2908
(310) 209-2011
(310) 209-2113
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
F1333
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182297503
—
TX
01
—
208087232
TRICARE/CHAMPUS
TX
01
—
8AD481
BLUE CROSS PPO
TX
01
—
P00429299
RAILROAD MEDICARE
TX
Enumeration date
06/28/2006
Last updated
08/14/2025
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