Provider Demographics
NPI:1467656165
Name:AHN, DEOK HEE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:DEOK
Middle Name:HEE
Last Name:AHN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2343 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2642
Mailing Address - Country:US
Mailing Address - Phone:626-590-5577
Mailing Address - Fax:626-463-1263
Practice Address - Street 1:2343 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108
Practice Address - Country:US
Practice Address - Phone:626-590-5577
Practice Address - Fax:626-463-1263
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11129171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist