Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 28822 | TX |
N | 213EG0000X | General Practice | 28822 | TX |
Y | 1223P0700X | Prosthodontist | 64658 | CA |
NPI | 1043504954 |
---|---|
Provider Name | Dr. Michelle Soojung Ahn |
First Address | Redondo Beach, CA 90278-4001 |
Second Address | Redondo Beach, CA 90278-4001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2011 |
Last Update Date | 04/05/2016 |