Provider Demographics
NPI:1528304581
Name:AHN, KYUNGJA (LAC)
Entity type:Individual
Prefix:
First Name:KYUNGJA
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W OLYMPIC BLVD
Mailing Address - Street 2:SUIT 208
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2637
Mailing Address - Country:US
Mailing Address - Phone:213-427-7600
Mailing Address - Fax:213-384-1101
Practice Address - Street 1:2727 W OLYMPIC BLVD
Practice Address - Street 2:SUIT 208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2637
Practice Address - Country:US
Practice Address - Phone:213-427-7600
Practice Address - Fax:213-384-1101
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14802171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist