MEDICARE: JHEESOO AHN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	SP034127	PA

General Provider Information

NPI Number	:	1174486989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JHEESOO AHN

Provider Business Mailing Address
First Line	:	4519 CHESTNUT ST UNIT 537
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-3969
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 CIVIC CENTER BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-5127
Country	:	US
Telephone Number	:	215-662-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ JHEESOO AHN ” Practice Location

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