Provider Demographics
NPI:1326067489
Name:AHN, SUNG MIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUNG MIN
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 1:16922 MAIN ST STE F
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6011
Mailing Address - Country:US
Mailing Address - Phone:760-244-4844
Mailing Address - Fax:
Practice Address - Street 1:16922 MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-6011
Practice Address - Country:US
Practice Address - Phone:760-244-4844
Practice Address - Fax:760-244-5002
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527061223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52706CAOtherDELTA DENTAL OF CALIFORNI
CAG93705-01Medicaid