Provider Demographics
NPI:1982868840
Name:AHN, JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
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 1:9669 KENTON AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1267
Mailing Address - Country:US
Mailing Address - Phone:847-933-0600
Mailing Address - Fax:847-933-0505
Practice Address - Street 1:9669 KENTON AVE STE 405
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1267
Practice Address - Country:US
Practice Address - Phone:847-933-0600
Practice Address - Fax:847-933-0505
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125054468208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics