Provider Demographics
NPI:1508113010
Name:AHN, ANNIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CORPORATE PARK
Mailing Address - Street 2:SUITE 300
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 CORPORATE PARK
Practice Address - Street 2:SUITE 300
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5144
Practice Address - Country:US
Practice Address - Phone:949-229-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22375103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling