Healthcare Provider Details

I. General information

NPI: 1053476416
Provider Name (Legal Business Name): LAURA Y AHN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 TELEGRAPH AVE # 117
OAKLAND CA
94609-1710
US

IV. Provider business mailing address

PO BOX 60000 # 74010
SAN FRANCISCO CA
94160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 510-570-3500
  • Fax: 415-369-1384
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number14685
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number620426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: