Provider Demographics
NPI:1740349422
Name:AHN, TAE MO (DC)
Entity type:Individual
Prefix:MR
First Name:TAE
Middle Name:MO
Last Name:AHN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:AHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:5358 33RD AVE NW STE 204
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1773
Mailing Address - Country:US
Mailing Address - Phone:253-853-7580
Mailing Address - Fax:253-853-7582
Practice Address - Street 1:5358 33RD AVENUE NW STE 204
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1773
Practice Address - Country:US
Practice Address - Phone:253-853-7580
Practice Address - Fax:253-853-7582
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH0034489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8857815Medicare PIN
WAV07829Medicare UPIN