Provider Demographics
NPI:1043742885
Name:AHN, PAULINE (MD)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 GOLF RD STE 900
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1244
Mailing Address - Country:US
Mailing Address - Phone:847-676-5394
Mailing Address - Fax:847-679-7183
Practice Address - Street 1:4709 GOLF RD STE 900
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1244
Practice Address - Country:US
Practice Address - Phone:847-676-5394
Practice Address - Fax:847-679-7183
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.152981208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program