Provider Demographics
NPI:1255326112
Name:AHN, MIN SHICK (MD)
Entity Type:Individual
Prefix:MR
First Name:MIN
Middle Name:SHICK
Last Name:AHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:67 BELMONT ST
Mailing Address - Street 2:STE 103
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2657
Mailing Address - Country:US
Mailing Address - Phone:508-755-8623
Mailing Address - Fax:508-752-5231
Practice Address - Street 1:67 BELMONT ST
Practice Address - Street 2:STE 103
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2657
Practice Address - Country:US
Practice Address - Phone:508-755-8623
Practice Address - Fax:508-752-5231
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA210134207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0141313Medicaid
G92109Medicare UPIN
MA0141313Medicaid