Provider Demographics
NPI:1790878437
Name:AHN, SHIN SUK (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHIN
Middle Name:SUK
Last Name:AHN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7612 LINDA VISTA ROAD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111
Mailing Address - Country:US
Mailing Address - Phone:858-279-0888
Mailing Address - Fax:858-292-0837
Practice Address - Street 1:7612 LINDA VISTA ROAD
Practice Address - Street 2:SUITE 112
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111
Practice Address - Country:US
Practice Address - Phone:858-279-0888
Practice Address - Fax:858-292-0837
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2017302931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice