Individual provider Active NPI

Jae Ahn, MD

  • Surgery Physician
  • Oklahoma City, OK
National Provider Identifier
1053102202
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
45722 Issued in OK
Practice address
800 Stanton L Young Blvd
Oklahoma City, OK 73104-5018
Phone
(405) 271-6308
NPI assigned
May 16, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 45722 OK Primary

Addresses

Primary practice location

800 Stanton L Young Blvd
Oklahoma City, OK 73104-5018

Mailing address

800 Stanton L Young Blvd
Oklahoma City, OK 73104-5018

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250728002035 OK Order and Referring Only - General SurgeryPractitioner - General Surgery 3173030921

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1747353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747353600000",
    "number": "1053102202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 STANTON L YOUNG BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 STANTON L YOUNG BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045018",
            "telephone_number": "405-271-6308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AHN",
        "first_name": "JAE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-16",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OK",
            "license": "45722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.