Provider Demographics
NPI:1205877982
Name:AHN, CHANG W (MD)
Entity type:Individual
Prefix:
First Name:CHANG
Middle Name:W
Last Name:AHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 GOOD DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4360
Mailing Address - Country:US
Mailing Address - Phone:717-735-2070
Mailing Address - Fax:
Practice Address - Street 1:90 GOOD DR
Practice Address - Street 2:SUITE 302
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4360
Practice Address - Country:US
Practice Address - Phone:717-735-2070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038832L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000955581Medicaid
PA000955581Medicaid
PA000955581Medicaid