Provider Demographics
NPI:1073859393
Name:AHN, YOUNG M
Entity Type:Individual
Prefix:MR
First Name:YOUNG
Middle Name:M
Last Name:AHN
Suffix:
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:PO BOX 6447
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-0447
Mailing Address - Country:US
Mailing Address - Phone:646-641-4501
Mailing Address - Fax:
Practice Address - Street 1:591 SUMMIT AVE STE 214
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2711
Practice Address - Country:US
Practice Address - Phone:646-641-4501
Practice Address - Fax:646-861-0669
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004739171100000X
NJ25MZ00094300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist