Provider Demographics
NPI:1619015724
Name:AHN, SEAN SUNG (LAC)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:SUNG
Last Name:AHN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20425 YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886
Mailing Address - Country:US
Mailing Address - Phone:714-779-8800
Mailing Address - Fax:714-779-8801
Practice Address - Street 1:20425 YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886
Practice Address - Country:US
Practice Address - Phone:714-779-8800
Practice Address - Fax:714-779-8801
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11303171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC11303OtherACUPUNCTURIST