Provider Demographics
NPI:1033815857
Name:AHN, JEONG YUN (DMD)
Entity Type:Individual
Prefix:
First Name:JEONG YUN
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 MONROE ST APT 388
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-7803
Mailing Address - Country:US
Mailing Address - Phone:617-780-0519
Mailing Address - Fax:
Practice Address - Street 1:3585 MONROE ST APT 388
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-7803
Practice Address - Country:US
Practice Address - Phone:617-780-0519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108487122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist