Provider Demographics
NPI:1558566943
Name:AHN, TAE JUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAE JUN
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 1:4010 SEPULVEDA BLVD.
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-378-5358
Mailing Address - Fax:
Practice Address - Street 1:4010 SEPULVEDA BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2372
Practice Address - Country:US
Practice Address - Phone:310-378-5358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA438841223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics