Healthcare Provider Details

I. General information

NPI: 1083610661
Provider Name (Legal Business Name): JUNG HWAN AHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 34TH ST
NEW YORK NY
10016-4901
US

IV. Provider business mailing address

400 E 34TH ST
NEW YORK NY
10016-4901
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-6122
  • Fax:
Mailing address:
  • Phone: 212-263-6122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number132107
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: