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General NPI Number Information
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NPI Number | 1902147499
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Entity Type | Individual
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Provider Name | JAECHOL AHN PT, L.AC
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Gender | Male
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Dates
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Enumeration Date | 03/07/2013
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 8523 BROADWAY UNIT D
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City | ELMHURST
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State | NY
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Zip | 11373-5866
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Country | US
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Telephone | 718-873-2303
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Fax |
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Provider Business Mailing Address
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Address Line | 3409 MURRAY ST FL 2
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City | FLUSHING
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State | NY
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Zip | 11354-3948
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Country | US
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Telephone | 718-888-1704
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Fax | 718-961-2459
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 006977
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 031899
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License Number State | NY
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