Provider Demographics
NPI:1023731486
Name:AHN, HONGJOON (MOTR/L)
Entity type:Individual
Prefix:
First Name:HONGJOON
Middle Name:
Last Name:AHN
Suffix:
Gender:M
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10346 SOUTHAM LN
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1787
Mailing Address - Country:US
Mailing Address - Phone:571-432-7220
Mailing Address - Fax:
Practice Address - Street 1:10346 SOUTHAM LN
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-1787
Practice Address - Country:US
Practice Address - Phone:571-432-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006495225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist