Basic Information
| Provider Information | |||||||||
| NPI: | 1083706147 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN H. AHN. D.O.;PL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1840 MEASE DR | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | SAFETY HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346956602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277964166 | ||||||||
| FaxNumber: | 7276695849 | ||||||||
| Practice Location | |||||||||
| Address1: | 1840 MEASE DR | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | SAFETY HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346956602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277964166 | ||||||||
| FaxNumber: | 7276695849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | AHN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7277964166 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | OS0007005 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 57158 | 01 | FL | BLUE SHIELD | OTHER | 3615915 | 01 | FL | AETNA | OTHER | 281931 | 01 | FL | AVMED | OTHER | 1598790701 | 01 | FL | INDIVIDUAL NPI | OTHER |