Provider Demographics
NPI:1750565016
Name:AHN, KYUNG HEUP (MD)
Entity type:Individual
Prefix:
First Name:KYUNG HEUP
Middle Name:
Last Name:AHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 JOHN ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1466
Mailing Address - Country:US
Mailing Address - Phone:203-429-4392
Mailing Address - Fax:844-704-5841
Practice Address - Street 1:184 LIBERTY ST
Practice Address - Street 2:YALE PSYCHIATRIC HOSPITAL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1625
Practice Address - Country:US
Practice Address - Phone:203-688-9907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045620208D00000X, 2084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program