Provider Demographics
NPI:1730683400
Name:AHN, DANIEL (PHYSICIAN)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:AHN
Suffix:
Gender:M
Credentials:PHYSICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 ORCHARD LAKE RD STE 316
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3629
Mailing Address - Country:US
Mailing Address - Phone:866-607-2308
Mailing Address - Fax:
Practice Address - Street 1:51 ATLANTIC AVE FL 100
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2741
Practice Address - Country:US
Practice Address - Phone:866-607-2308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11111300207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine