MEDICARE: JEONG YUN AHN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	108487	CA

General Provider Information

NPI Number	:	1033815857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEONG YUN AHN DMD

Provider Business Mailing Address
First Line	:	3585 MONROE ST APT 388
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-7803
Country	:	US
Telephone Number	:	617-780-0519
Fax Number	:

Provider Business Practice Location Address
First Line	:	3585 MONROE ST APT 388
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-7803
Country	:	US
Telephone Number	:	617-780-0519
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2023
Last Update Date	:	02/02/2023

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