Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 31950 | NE |
NPI | 1013419076 |
---|---|
Provider Name | Dr. Hannah Ghong-Ju Ahn |
First Address | Tacoma, WA 98431-0001 |
Second Address | Tacoma, WA 98431-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2018 |
Last Update Date | 07/11/2019 |