Provider Demographics
NPI:1003923764
Name:AHN, TAE-JUN (DPM)
Entity type:Individual
Prefix:DR
First Name:TAE-JUN
Middle Name:
Last Name:AHN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 PLEASANT LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-1847
Mailing Address - Country:US
Mailing Address - Phone:773-989-2500
Mailing Address - Fax:877-834-6714
Practice Address - Street 1:1640 PLEASANT LN
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-1847
Practice Address - Country:US
Practice Address - Phone:773-989-2500
Practice Address - Fax:877-834-6714
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005105213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005105Medicaid
ILP00631105OtherMEDICARE RAILROAD
IL016005105Medicaid
ILK39582Medicare PIN
IL5899010001Medicare NSC