Provider Demographics
NPI:1518119213
Name:AHN, DONG-NAM (DC, LAC)
Entity Type:Individual
Prefix:
First Name:DONG-NAM
Middle Name:
Last Name:AHN
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 HIGHFIELD LN
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1930
Mailing Address - Country:US
Mailing Address - Phone:201-724-1929
Mailing Address - Fax:
Practice Address - Street 1:44 HIGHFIELD LN
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1930
Practice Address - Country:US
Practice Address - Phone:201-724-1929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00588900111N00000X
NYX010212-1111N00000X
NY003310-1171100000X
NJ25MZ00083100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor