Provider Demographics
NPI:1104944172
Name:AHN, NA YOUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:NA YOUNG
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1984 FOXWORTHY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-1509
Mailing Address - Country:US
Mailing Address - Phone:408-377-2225
Mailing Address - Fax:408-377-2226
Practice Address - Street 1:1984 FOXWORTHY AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-1509
Practice Address - Country:US
Practice Address - Phone:408-377-2225
Practice Address - Fax:408-377-2226
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2013-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54603122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD54603OtherDENTICAL PROVIDER NUMBER