Provider Demographics
NPI:1932138062
Name:Y.C. AHN, M.D., P.L.L.C.
Entity Type:Organization
Organization Name:Y.C. AHN, M.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YOO
Authorized Official - Middle Name:CHUL
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-243-0100
Mailing Address - Street 1:1800 W 1ST ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-3133
Mailing Address - Country:US
Mailing Address - Phone:580-243-0100
Mailing Address - Fax:580-243-0807
Practice Address - Street 1:1800 W 1ST ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-3133
Practice Address - Country:US
Practice Address - Phone:580-243-0100
Practice Address - Fax:580-243-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11651174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK091565914-001OtherBLUE CROSS BLUE SHIELD