Provider Demographics
NPI:1841293131
Name:DR YANG AHN, MD, PC
Entity type:Organization
Organization Name:DR YANG AHN, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-396-2000
Mailing Address - Street 1:9255 ATLANTIC DR SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-8950
Mailing Address - Country:US
Mailing Address - Phone:319-396-2000
Mailing Address - Fax:319-396-5567
Practice Address - Street 1:9255 ATLANTIC DR SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-8950
Practice Address - Country:US
Practice Address - Phone:319-396-2000
Practice Address - Fax:319-396-5567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0114496Medicaid
IA56317Medicare PIN
IACO1415Medicare PIN
IACK3996Medicare PIN
IA02681Medicare PIN
IA0114496Medicaid