# MODERN VEIN PROVIDERS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346010527
- **Authorized official:** JIYONG AHN MD (DOCTOR)
- **Authorized official phone:** (860) 574-3423

## Contact information

- **Practice address:** 903 HARTFORD TPKE, WATERFORD, CT 06385-4264
- **Practice address phone:** (860) 574-3423
- **Practice address fax:** (860) 222-9082
- **Mailing address:** 903 HARTFORD TPKE, WATERFORD, CT 06385-4264
- **Mailing address phone:** (860) 574-3423
- **Mailing address fax:** (860) 222-9082

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | NULL | Yes |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/08/2024
- **Last updated:** 01/08/2024