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1790238707 NPI number — EUN JEONG AHN

NPI Number: 1790238707
Health Care Provider/Practitioner: EUN JEONG AHN

Information about “1790238707” NPI (EUN JEONG AHN) exists in 1790238707 in HTML format HTML  |  1790238707 in plain Text format TXT  |  1790238707 in PDF (Portable Document Format) PDF  |  1790238707 in an XML format XML  formats.

NPI Number : 1790238707 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790238707",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "AHN",
    "FirstName": "EUN JEONG",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "430 MILWAUKEE AVE",
    "SecondLineMailingAddress": "SUITE 203",
    "MailingAddressCityName": "LINCOLNSHIRE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60069-3015",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "847-282-0279",
    "MailingAddressFaxNumber": "224-352-2987",
    "FirstLinePracticeLocationAddress": "430 MILWAUKEE AVE",
    "SecondLinePracticeLocationAddress": "SUITE 203",
    "PracticeLocationAddressCityName": "LINCOLNSHIRE",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60069-3015",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "847-282-0279",
    "PracticeLocationAddressFaxNumber": "224-352-2987",
    "EnumerationDate": "07/26/2016",
    "LastUpdateDate": "07/26/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223X0400X",
        "TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
        "LicenseNumber": "021002473",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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