MEDICARE: MRS. DEOK HEE AHN LAC.

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	171100000X	Acupuncturist	11129	CA

General Provider Information

NPI Number	:	1467656165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEOK HEE AHN LAC.

Provider Business Mailing Address
First Line	:	2343 HUNTINGTON DR
Second Line	:
City	:	SAN MARINO
State	:	CA
Zip	:	91108-2642
Country	:	US
Telephone Number	:	626-590-5577
Fax Number	:	626-463-1263

Provider Business Practice Location Address
First Line	:	2343 HUNTINGTON DR
Second Line	:
City	:	SAN MARINO
State	:	CA
Zip	:	91108
Country	:	US
Telephone Number	:	626-590-5577
Fax Number	:	626-463-1263

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	07/11/2018

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