Provider Demographics
NPI:1649968991
Name:AHN, RUBY KATHARINA (LMT)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:KATHARINA
Last Name:AHN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 ALA NAPUAA PL APT 401
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-2747
Mailing Address - Country:US
Mailing Address - Phone:808-892-0949
Mailing Address - Fax:
Practice Address - Street 1:1122 WILDER AVE APT 105
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2751
Practice Address - Country:US
Practice Address - Phone:808-630-6552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT3691225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty