Provider Demographics
NPI:1235493602
Name:AH, JIN (LAC)
Entity Type:Individual
Prefix:
First Name:JIN
Middle Name:
Last Name:AH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2425 CAMINO DEL RIO SOUTH
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92118
Mailing Address - Country:US
Mailing Address - Phone:619-467-6067
Mailing Address - Fax:
Practice Address - Street 1:2425 CAMINO DE RIO SOUTH
Practice Address - Street 2:SUITE 180
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92118
Practice Address - Country:US
Practice Address - Phone:619-467-6067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14781171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist