Soo Ryun Ahn, MD
Individual provider Active NPI Family Medicine Physician · Raymond, WA
NPI 1356802433 · NPPES record last updated Aug 25, 2022
Key facts
- NPI
- 1356802433
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD61332660 (WA)
- Practice address
- 300 Ocean Ave
Raymond, WA 98577-3016 - Phone
- (360) 942-3040
- Fax
- (360) 942-3955
- NPI assigned
- Mar 29, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 15
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lewis County Community Health Services
Practice addresses (Care Compare)
2690 NE Kresky Ave
Chehalis, WA 98532-2412
Phone (360) 330-9595
Hospital & facility affiliations
- Harbors Home Health / Hospice
- Willapa Harbor Hospital
- Providence Centralia Hospital
- Grays Harbor Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221024001639 | WA | Practitioner - Family Practice | 0042686651 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD61332660 | WA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lewis County Community Health Services | Current |
Accepting new patients | |
| Lewis County Community Health Services | Current | Accepting new patients | |
| Lewis County Community Health Services | Current |
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
- https://api.platform.athenahealth.com/1599/brand/1/csg/341/fhir/r4
- sooryun.ahn.p1@direct.valleyviewhc.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD61332660 | WA | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2215614 | Medicaid | WA |
Other providers in Raymond, WA
All providers in Raymond, WA · Family Medicine Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.