Provider Demographics
NPI:1780773275
Name:AHN, CHADWICK NEAL (MD)
Entity type:Individual
Prefix:DR
First Name:CHADWICK
Middle Name:NEAL
Last Name:AHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:279 KINGS DAUGHTERS DR
Mailing Address - Street 2:202
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-6561
Mailing Address - Country:US
Mailing Address - Phone:502-226-6494
Mailing Address - Fax:502-226-6493
Practice Address - Street 1:279 KINGS DAUGHTERS DR
Practice Address - Street 2:202
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-6561
Practice Address - Country:US
Practice Address - Phone:502-226-6494
Practice Address - Fax:502-226-6493
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL27208207Y00000X
KY42511207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100074950Medicaid
KY0990503Medicare PIN