Provider Demographics
NPI:1639671373
Name:AHN, JUDY SARAH
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:SARAH
Last Name:AHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 TYRELLA AVE APT 20
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-2144
Mailing Address - Country:US
Mailing Address - Phone:650-961-1214
Mailing Address - Fax:
Practice Address - Street 1:260 S SUNNYVALE AVE STE 8
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-6273
Practice Address - Country:US
Practice Address - Phone:408-736-3676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17830171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist