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General NPI Number Information
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NPI Number | 1801531371
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Entity Type | Individual
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Provider Name | JI HYUN AN
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Gender | Female
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Dates
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Enumeration Date | 04/29/2022
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Last Update Date | 01/11/2025
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Provider Practice Location Address
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Address Line | 23844 S POWER RD STE B-106
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-6152
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Country | US
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Telephone | 602-661-6983
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Fax |
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Provider Business Mailing Address
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Address Line | 1666 S DOBSON RD APT 4062
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City | MESA
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State | AZ
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Zip | 85202-1614
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Country | US
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Telephone | 303-748-8796
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D011684
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License Number State | AZ
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