Provider Demographics
NPI:1386800647
Name:AHN, TAI JUNG (LAC)
Entity type:Individual
Prefix:
First Name:TAI JUNG
Middle Name:
Last Name:AHN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4346 MATILIJA AVE
Mailing Address - Street 2:APT 109
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11239 VENTURA BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3163
Practice Address - Country:US
Practice Address - Phone:818-508-6888
Practice Address - Fax:818-508-6778
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11912171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist