Basic Information
| Provider Information | |||||||||
| NPI: | 1912341447 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AHN | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | JUNHYUK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | HEALTH SCIENCE TOWER LEVEL 18, ROOM 051 | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117948191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314442704 | ||||||||
| FaxNumber: | 6314447784 | ||||||||
| Practice Location | |||||||||
| Address1: | HEALTH SCIENCE TOWER LEVEL 19, ROOM 030 | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117943412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314441791 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2013 | ||||||||
| LastUpdateDate: | 09/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 63283 | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208600000X | 306605 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.