Provider Demographics
NPI:1023375847
Name:AHN, ESTHER
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 WILSHIRE BLVD
Mailing Address - Street 2:#208
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3722
Mailing Address - Country:US
Mailing Address - Phone:213-477-4731
Mailing Address - Fax:
Practice Address - Street 1:10100 CULVER BLVD STE A
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3174
Practice Address - Country:US
Practice Address - Phone:310-423-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA128139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program