Provider Demographics
NPI:1609293406
Name:AHN, CHRISTINE JAE EUN (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JAE EUN
Last Name:AHN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 S CANFIELD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4349
Mailing Address - Country:US
Mailing Address - Phone:619-325-9281
Mailing Address - Fax:
Practice Address - Street 1:28212 KELLY JOHNSON PKWY STE 170
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5087
Practice Address - Country:US
Practice Address - Phone:661-257-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA642721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice