Provider Demographics
NPI:1861003576
Name:AHN, SE EUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SE EUN
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ADEL
Other - Middle Name:
Other - Last Name:AHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1607 HARMON ST APT 101
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-4112
Mailing Address - Country:US
Mailing Address - Phone:510-926-1181
Mailing Address - Fax:
Practice Address - Street 1:1647 ADMIRAL TAUSSIG BLVD STE 241
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-2803
Practice Address - Country:US
Practice Address - Phone:757-953-8635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1052631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice