MEDICARE: DR. SUKCHAN PAUL AHN DDS

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	122300000X	Dentist	0526091	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770678658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUKCHAN PAUL AHN DDS

Provider Business Mailing Address
First Line	:	475 48TH AVE
Second Line	:	#212
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5600
Country	:	US
Telephone Number	:	917-825-2716
Fax Number	:

Provider Business Practice Location Address
First Line	:	3411 STEINWAY ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11101-1319
Country	:	US
Telephone Number	:	718-392-1888
Fax Number	:	718-392-6979

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	08/30/2007

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