Healthcare Provider Details

I. General information

NPI: 1740119460
Provider Name (Legal Business Name): SEONGHAN AHN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 WILMETTE AVE
WILMETTE IL
60091-2135
US

IV. Provider business mailing address

2911 WILMETTE AVE
WILMETTE IL
60091-2135
US

V. Phone/Fax

Practice location:
  • Phone: 224-800-2857
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198.001671
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: