Provider Demographics
NPI:1902802838
Name:AHN, JOHN JOON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOON
Last Name:AHN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:145 HOSPITAL AVE
Mailing Address - Street 2:STE 113
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1463
Mailing Address - Country:US
Mailing Address - Phone:814-375-3722
Mailing Address - Fax:814-375-3363
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:STE 113
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1463
Practice Address - Country:US
Practice Address - Phone:814-375-3722
Practice Address - Fax:814-375-3363
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2014-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD422089207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01959413Medicaid
PAF87198Medicare UPIN
PA01959413Medicaid