Provider Demographics
NPI:1073542163
Name:AHN, YOO CHUL (MD)
Entity Type:Individual
Prefix:DR
First Name:YOO
Middle Name:CHUL
Last Name:AHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W 1ST ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-3133
Mailing Address - Country:US
Mailing Address - Phone:580-243-0100
Mailing Address - Fax:580-243-0807
Practice Address - Street 1:1800 W 1ST ST
Practice Address - Street 2:SUITE #1
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-3133
Practice Address - Country:US
Practice Address - Phone:580-243-0100
Practice Address - Fax:580-243-0807
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11651174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100011090AMedicaid
OK100011090AMedicaid