Provider Demographics
NPI:1275551277
Name:AHN, JONG GILL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONG GILL
Middle Name:
Last Name:AHN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-4101
Mailing Address - Country:US
Mailing Address - Phone:760-375-3988
Mailing Address - Fax:760-375-1555
Practice Address - Street 1:133 E CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-4101
Practice Address - Country:US
Practice Address - Phone:760-375-3988
Practice Address - Fax:760-375-1555
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADW034045122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist