Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 036104840 | IL |
NPI | 1083681027 |
---|---|
Provider Name | Dr. Joon S Ahn |
First Address | Mount Vernon, IL 62864-6262 |
Second Address | Mount Vernon, IL 62864-6262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036104840 | (05) | IL |
H46109 | (02) | IL |