Provider Demographics
NPI:1053057836
Name:AHN, JOHAN K JR
Entity Type:Individual
Prefix:MR
First Name:JOHAN
Middle Name:K
Last Name:AHN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7008 BALMORAL FOREST RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-1538
Mailing Address - Country:US
Mailing Address - Phone:425-505-1307
Mailing Address - Fax:
Practice Address - Street 1:1645 CONNECTICUT AVE NW APT 3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1054
Practice Address - Country:US
Practice Address - Phone:202-297-7404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121001049171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty