Individual provider Active NPI

Johan K. Ahn, MD

  • Diagnostic Radiology Physician
  • Tacoma, WA
National Provider Identifier
1972546240
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
A84698 Issued in CA
Practice address
1304 Fawcett Ave Ste 100
Tacoma, WA 98402-1900
Phone
(253) 761-4200
Fax
(253) 761-4201
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MD151077 OR
Diagnostic Radiology Physician 2085R0202X MD-9933 HI
Diagnostic Radiology Physician 2085R0202X MD00042505 WA
Diagnostic Radiology Physician 2085R0202X A84698 CA Primary

Addresses

Primary practice location

1304 Fawcett Ave Ste 100
Tacoma, WA 98402-1900

Mailing address

PO Box 1535
Tacoma, WA 98401-1535
Phone (253) 761-4200

Other practice location 1

1301 Punchbowl St
Honolulu, HI 96813-2499
Phone (808) 691-1000

Other identifiers 3

IdentifierTypeStateIssuer
8399263MedicaidWA
1060681MedicaidOR
1060681MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, CA, OR, HI4 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20040802000492 WA Practitioner - Diagnostic Radiology 4183695547
I20050421001196 CA Practitioner - Diagnostic Radiology 4183695547 Reassigns benefits to 7 organizations
I20100917000558 OR Practitioner - Diagnostic RadiologyPractitioner - Radiation Oncology 4183695547 Reassigns benefits to 1 organization
I20220822000739 HI Practitioner - Diagnostic Radiology 4183695547 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
New York Medical College, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Queens University Medical GroupGroup PAC ID 2466831557, 614 clinicians

Practice addresses (Care Compare)

1215 Hunakai St
Honolulu, HI 96816-4661
Phone (808) 691-8200

1301 Punchbowl St
Honolulu, HI 96813-2499

1380 Lusitana St
Honolulu, HI 96813-2448

1401 S Beretania St
Suite 750
Honolulu, HI 96814-1881
Phone (808) 691-8526

449 Kapahulu Ave
Suite 104
Honolulu, HI 96815-3850
Phone (808) 735-0007

67-1125 Mamalaho Hwy
Kamuela, HI 96743-8496
Phone (808) 881-4400

801 S Main St
Corona, CA 92882-3410

94 -1144 Ka Uka Blvd
Suite 7
Waipahu, HI 96797-4483
Phone (808) 686-4010

98-199 Kamehameha Hwy
BLDG F
Aiea, HI 96701-4821
Phone (808) 735-0007

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A84698CAMDDiagnostic Radiology Physician
MD-9933HIMDDiagnostic Radiology Physician
MD00042505WAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beverly Radiology Medical Group III Diagnostic Radiology CurrentSince Sep 15, 2024 Accepting new patients
Norcal Imaging Diagnostic Radiology CurrentSince Dec 12, 2024 Accepting new patients
Cedars-Sinai Medical Care Foundation CurrentSince Jan 1, 2025 Accepting new patients
Norcal Imaging - Open MRI of Walnut Creek Diagnostic Radiology CurrentSince Dec 12, 2024 Accepting new patients
North Hawaii Community Hospital, Inc. CurrentSince Apr 20, 2025 Accepting new patients
Desert Advanced Imaging Medical Center Diagnostic Radiology CurrentSince Sep 15, 2024 Accepting new patients
Cedars-Sinai Medical Care Foundation CurrentSince Jan 1, 2025 Accepting new patients
Beverly Radiology Medical Group III Diagnostic Radiology CurrentSince Apr 1, 2025 Accepting new patients
Beverly Radiology Medical Group III Diagnostic Radiology CurrentSince Sep 15, 2024 Accepting new patients
Diagnostic Radiological Imaging Diagnostic Radiology CurrentSince Sep 15, 2024 Accepting new patients
Beverly Radiology Medical Group III Diagnostic Radiology CurrentSince Sep 15, 2024 Accepting new patients
Kauai Medical Clinic CurrentSince Jul 13, 2022 Accepting new patients
Queens University Medical Group CurrentSince Jul 1, 2023 Accepting new patients
Tra-Minw, PS Diagnostic Radiology CurrentSince Jun 22, 2021 Accepting new patients
Queens North Hawaii Community Hospital CurrentSince Apr 20, 2025 Accepting new patients
Kauai Medical Clinic CurrentSince Jul 13, 2022 Accepting new patients
Radia Inc P S Diagnostic Radiology Past Accepting new patients
Swedish Medical Center-Radia Issaquah Imaging Center LLC Diagnostic Radiology Past Accepting new patients
Advanced Medical Imaging Center LLC Diagnostic Radiology Past Accepting new patients
Everett Radia LLC Diagnostic Radiology Past Accepting new patients
Evergreen Radia LLC Diagnostic Radiology Past Accepting new patients

Locations (25 of 32)

18523 Corwin Rd
Ste J
Apple Valley, CA 92307
Phone (760) 242-4444

8750 Wilshire Blvd
Ste 100
Beverly Hills, CA 90211
Phone (310) 689-3100

2601 W Alameda Ave
Ste 101
Burbank, CA 91505
Phone (818) 843-7462

2300 Clayton Rd
Ste 160
Concord, CA 94520
Phone (925) 825-7777

801 S Main St
Ste 101
Corona, CA 92882
Phone (951) 682-1099

801 S Main St
Ste 205
Corona, CA 92882
Phone (951) 351-1025

16130 Ventura Blvd
Ste 100
Encino, CA 91436
Phone (818) 933-2020

2201 Walnut Ave
Ste 150
Fremont, CA 94538
Phone (510) 713-1234

6107 N Fresno St
Ste 101
Fresno, CA 93710
Phone (559) 435-4433

9191 Westminster Ave
Ste 105
Garden Grove, CA 92844
Phone (714) 583-6314

250 S 12th Ave
Hanford, CA 93230
Phone (559) 295-2450

2679 Zoe Ave
Huntington Park, CA 90255
Phone (323) 584-3333

11360 Mountain View Ave
Ste C
Loma Linda, CA 92354
Phone (909) 478-3300

3715 E South St
Long Beach, CA 90805
Phone (562) 602-0700

3320 N Los Coyotes Diagonal
Ste 120
Long Beach, CA 90808
Phone (562) 627-0903

8635 W 3rd St
Ste 465W
Los Angeles, CA 90048
Phone (310) 423-0674

8436 W 3rd St
Ste 600
Los Angeles, CA 90048
Phone (310) 358-2100

27168 Newport Rd
Ste B
Menifee, CA 92584
Phone (951) 566-5725

25395 Hancock Ave
#1101112
Murrieta, CA 92562
Phone (951) 696-4230

3909 Waring Rd
Ste Bc
Oceanside, CA 92056
Phone (760) 630-0014

72855 Fred Waring Dr
Palm Desert, CA 92260
Phone (760) 837-1420

2601 E Tahquitz Canyon Way
Palm Springs, CA 92262
Phone (760) 318-2980

35800 Bob Hope Dr
Ste 150A
Rancho Mirage, CA 92270
Phone (760) 770-1920

79 Scripps Dr
Ste 100
Sacramento, CA 95825
Phone (916) 921-1200

2950 Sycamore Dr
Ste 102
Simi Valley, CA 93065
Phone (805) 357-0067

Organizations & group practices 22

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

View all 22

Hospital & facility affiliations 1

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1972546240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1535",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984011535",
            "telephone_number": "253-761-4200",
            "fax_number": "253-383-3553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 FAWCETT AVE STE 100",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984021900",
            "telephone_number": "253-761-4200",
            "fax_number": "253-761-4201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 Punchbowl St",
            "address_purpose": "LOCATION",
            "city": "Honolulu",
            "state": "HI",
            "postal_code": "968132499",
            "country_code": "US",
            "telephone_number": "808-691-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AHN",
        "first_name": "JOHAN",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "MD151077",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "HI",
            "license": "MD-9933",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD00042505",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A84698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8399263",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1060681",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1060681",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.