Healthcare Provider Details

I. General information

NPI: 1275446312
Provider Name (Legal Business Name): JASON AHN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W 6TH ST
LOS ANGELES CA
90057-3113
US

IV. Provider business mailing address

215 S OCCIDENTAL BLVD APT 303
LOS ANGELES CA
90057-1294
US

V. Phone/Fax

Practice location:
  • Phone: 121-386-7630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: