Provider Demographics
NPI:1871585216
Name:AHN, CHONG H (MD)
Entity type:Individual
Prefix:DR
First Name:CHONG
Middle Name:H
Last Name:AHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1430 N. ARLINGTON HEIGHTS RD #104
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004
Mailing Address - Country:US
Mailing Address - Phone:847-253-5985
Mailing Address - Fax:847-253-0336
Practice Address - Street 1:1430 N. ARLINGTON HEIGHTS RD #104
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004
Practice Address - Country:US
Practice Address - Phone:847-253-5985
Practice Address - Fax:847-253-0336
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-051567207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051567Medicaid
IL036051567Medicaid
IL633480Medicare PIN
D14100Medicare UPIN