Provider Demographics
NPI:1770887630
Name:AHN, HEAYOUN (DAOM DAC LAC)
Entity type:Individual
Prefix:
First Name:HEAYOUN
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:DAOM DAC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SEDGEWICK
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-2156
Mailing Address - Country:US
Mailing Address - Phone:714-397-0709
Mailing Address - Fax:714-260-9315
Practice Address - Street 1:13732 NEWPORT AVE
Practice Address - Street 2:#6
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4665
Practice Address - Country:US
Practice Address - Phone:714-397-0709
Practice Address - Fax:714-260-9315
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12413171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist