Provider Demographics
NPI:1811192933
Name:AHN, JAE HO (DDS)
Entity Type:Individual
Prefix:
First Name:JAE
Middle Name:HO
Last Name:AHN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11066 5TH AVE NE
Mailing Address - Street 2:SUITE #203
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6156
Mailing Address - Country:US
Mailing Address - Phone:206-200-9683
Mailing Address - Fax:206-361-1156
Practice Address - Street 1:11066 5TH AVE NE
Practice Address - Street 2:SUITE #203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6156
Practice Address - Country:US
Practice Address - Phone:206-200-9683
Practice Address - Fax:206-361-1156
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010888122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist