Provider Demographics
NPI:1407299043
Name:AHN, JUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUNG
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 1:171 E 89TH ST
Mailing Address - Street 2:#4C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2381
Mailing Address - Country:US
Mailing Address - Phone:615-275-7299
Mailing Address - Fax:
Practice Address - Street 1:266 E 167TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-4017
Practice Address - Country:US
Practice Address - Phone:718-293-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-13
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0573941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program