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General NPI Number Information
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NPI Number | 1225220502
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Entity Type | Individual
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Provider Name | YONG SOO AHN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 04/08/2014
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Provider Practice Location Address
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Address Line | 1390 S ARCH AVE
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City | ALLIANCE
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State | OH
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Zip | 44601-4111
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Country | US
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Telephone | 330-821-3961
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Fax | 330-821-0232
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Provider Business Mailing Address
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Address Line | 2042 E 115TH ST
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City | CLEVELAND
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State | OH
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Zip | 44106-2330
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Country | US
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Telephone | 201-406-2777
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 055349
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 30-024035
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License Number State | OH
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