Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DDS103268 | CA |
N | 1223X0400X | Orthodontists | LL-383-14 | NV |
NPI | 1023416120 |
---|---|
Provider Name | Ji Hyun Ahn |
First Address | Henderson, NV 89014-2016 |
Second Address | Los Angeles, CA 90089-2016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2014 |
Last Update Date | 11/03/2021 |