Basic Information
| Provider Information | |||||||||
| NPI: | 1598790701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AHN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 EXECUTIVE DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337625323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273470005 | ||||||||
| FaxNumber: | 7275416558 | ||||||||
| Practice Location | |||||||||
| Address1: | 1840 MEASE DRIVE | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | SAFETY HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277964166 | ||||||||
| FaxNumber: | 7276695849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | OS7005 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 281931 | 01 | AVMED | OTHER | 5676415 | 01 | AETNA | OTHER | 57158 | 01 | BCBS | OTHER | 1136014 | 01 | FIRST HEALTH | OTHER | 4775800 | 01 | CIGNA | OTHER | 300384100 | 05 | FL | MEDICAID |