1932324670 NPI number — DR. WENDY NI AHN OD

Table of content: DR. WENDY NI AHN OD (NPI 1932324670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932324670 NPI number — DR. WENDY NI AHN OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHN
Provider First Name:
WENDY
Provider Middle Name:
NI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NI
Provider Other First Name:
WENDY
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1932324670
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 DEL MONTE AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ALTOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-947-0671
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
261 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ALTOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94022-2909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-947-3937
Provider Business Practice Location Address Fax Number:
650-947-3935
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  12738T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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