Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 4244 | AZ |
NPI | 1003085341 |
---|---|
Provider Name | Sungil Ahn |
First Address | Tempe, AZ 85282-7595 |
Second Address | Tempe, AZ 85282-7595 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2008 |
Last Update Date | 20/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
131178 | (05) | AZ |