Provider Demographics
NPI:1720299043
Name:AHN, JEE (DDS)
Entity Type:Individual
Prefix:
First Name:JEE
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13151 FOUNTAIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2031
Mailing Address - Country:US
Mailing Address - Phone:213-820-8916
Mailing Address - Fax:
Practice Address - Street 1:355 W MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-3327
Practice Address - Country:US
Practice Address - Phone:323-751-4108
Practice Address - Fax:323-751-2853
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53188122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist