Healthcare Provider Details

I. General information

NPI: 1831963891
Provider Name (Legal Business Name): YAEIN AHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRENE AHN

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16306 BOTHELL EVERETT HWY
MILL CREEK WA
98012-1283
US

IV. Provider business mailing address

16306 BOTHELL EVERETT HWY STE B
MILL CREEK WA
98012-1283
US

V. Phone/Fax

Practice location:
  • Phone: 425-745-4661
  • Fax:
Mailing address:
  • Phone: 425-745-4661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberYAYA0113
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: