Byong Jik Ahn, M.D.
Individual provider Active NPI Specialist · Elyria, OH
NPI 1295766053 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1295766053
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 35040472A (OH)
- Practice address
- 347 Midway Blvd
Suite 110
Elyria, OH 44035-9006 - Phone
- (440) 324-5555
- Fax
- (440) 324-5512
- NPI assigned
- Jul 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35040472A | OH | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Byong J. Ahn, M.D. & Associates | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 35040472A | OH | Yes |
Addresses
Primary practice location
347 Midway Blvd
Suite 110
Elyria, OH 44035-9006
Mailing address
347 Midway Blvd
Suite 110
Elyria, OH 44035-9006
Phone (440) 324-5555
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0464680 | Medicaid | OH |
Other providers in Elyria, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.