Provider Demographics
NPI:1770678658
Name:AHN, SUKCHAN PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUKCHAN
Middle Name:PAUL
Last Name:AHN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 48TH AVE
Mailing Address - Street 2:#212
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5600
Mailing Address - Country:US
Mailing Address - Phone:917-825-2716
Mailing Address - Fax:
Practice Address - Street 1:3411 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11101-1319
Practice Address - Country:US
Practice Address - Phone:718-392-1888
Practice Address - Fax:718-392-6979
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0526091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02887130Medicaid