Provider Demographics
NPI:1275851438
Name:AHN, YOUNG JIN (OMD, LAC)
Entity Type:Individual
Prefix:
First Name:YOUNG JIN
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 N BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1702
Mailing Address - Country:US
Mailing Address - Phone:714-580-3482
Mailing Address - Fax:
Practice Address - Street 1:1126 N BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1702
Practice Address - Country:US
Practice Address - Phone:714-533-1495
Practice Address - Fax:714-533-6040
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9987171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist