MEDICARE: JANE AHN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	66148	CA

General Provider Information

NPI Number	:	1093090383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE AHN

Provider Business Mailing Address
First Line	:	4667 MACARTHUR BLVD STE 320
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-1867
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4667 MACARTHUR BLVD STE 320
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-1867
Country	:	US
Telephone Number	:	949-375-9220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2011
Last Update Date	:	01/11/2013

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Directions to “ JANE AHN ” Practice Location

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