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General NPI Number Information
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NPI Number | 1417299272
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Entity Type | Organization
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Legal Business Name | SEED PEDIATRICS S.C.
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Dates
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Enumeration Date | 03/20/2013
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 9669 N KENTON AVE STE 405
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City | SKOKIE
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State | IL
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Zip | 60076
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Country | US
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Telephone | 202-203-0440
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Fax |
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Provider Business Mailing Address
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Address Line | 9669 N KENTON AVE STE 405
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City | SKOKIE
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State | IL
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Zip | 60076
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSCIAN
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Name | JONATHAN AHN
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Credential | M.D.
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Telephone | 202-203-0440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036127154
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License Number State | IL
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