NPIMap

Individual provider Active NPI

Soo Ryun Ahn, MD

  • Family Medicine Physician
  • Raymond, WA
National Provider Identifier
1356802433
Registry record updated Aug 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD61332660 Issued in WA
Practice address
300 Ocean Ave
Raymond, WA 98577-3016
Phone
(360) 942-3040
Fax
(360) 942-3955
NPI assigned
Mar 29, 2019
Last updated
Aug 25, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD61332660 WA Primary

Addresses

Primary practice location

300 Ocean Ave
Raymond, WA 98577-3016

Mailing address

2690 NE Kresky Ave
Chehalis, WA 98532-2412
Phone (360) 330-9595

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221024001639 WA Practitioner - Family Practice 0042686651 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2690 NE Kresky Ave
Chehalis, WA 98532-2412
Phone (360) 330-9595

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Lewis County Community Health Services Current Accepting new patients
Lewis County Community Health Services CurrentSince Sep 19, 2022 Accepting new patients
Lewis County Community Health Services CurrentSince Sep 19, 2022 Accepting new patients
Lewis County Community Health Services Past Accepting new patients
Foley Clinic Corp Past Accepting new patients
Lewis County Community Health Services Past Accepting new patients

Locations

2690 NE Kresky Ave
Chehalis, WA 98532
Phone (360) 330-9595

300 Ocean Ave
Raymond, WA 98577
Phone (360) 942-2303

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1599/brand/1/csg/341/fhir/r4
  • Direct secure messaging: sooryun.ahn.p1@direct.valleyviewhc.nextgenshare.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661385600000",
    "number": "1356802433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2690 NE KRESKY AVE",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985322412",
            "telephone_number": "360-330-9595",
            "fax_number": "360-330-9560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 OCEAN AVE",
            "city": "RAYMOND",
            "state": "WA",
            "postal_code": "985773016",
            "telephone_number": "360-942-3040",
            "fax_number": "360-942-3955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AHN",
        "first_name": "SOO RYUN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-29",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD61332660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raymond, WA

Sources for this page

Verify at the official NPI Registry.