Individual
CHANOOK AHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1127 WILSHIRE BLVD, LOS ANGELES, CA 90017-3901
(213) 481-0664
Mailing address
9213 SUNSHINE PL, DOWNEY, CA 90240-2563
(608) 354-7113
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
101227
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101227
DENTAL BOARD OF CALIFORNIA
CA
Enumeration date
06/07/2013
Last updated
07/22/2019
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