Provider Demographics
NPI:1669044277
Name:AHN, KAY (EDM)
Entity Type:Individual
Prefix:MR
First Name:KAY
Middle Name:
Last Name:AHN
Suffix:
Gender:M
Credentials:EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2927
Mailing Address - Country:US
Mailing Address - Phone:714-527-6561
Mailing Address - Fax:
Practice Address - Street 1:451 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2927
Practice Address - Country:US
Practice Address - Phone:714-527-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program