Provider Demographics
NPI:1568909901
Name:AHN, PETER KEYWON (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:KEYWON
Last Name:AHN
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20800 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-2707
Mailing Address - Country:US
Mailing Address - Phone:818-883-2273
Mailing Address - Fax:818-347-2446
Practice Address - Street 1:20800 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-2707
Practice Address - Country:US
Practice Address - Phone:818-883-2273
Practice Address - Fax:818-347-2446
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95005656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily