Provider Demographics
NPI:1730953290
Name:AHN, MIN SIK (LAC)
Entity type:Individual
Prefix:DR
First Name:MIN SIK
Middle Name:
Last Name:AHN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 HYLAND HILLS ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-8736
Mailing Address - Country:US
Mailing Address - Phone:720-394-7665
Mailing Address - Fax:
Practice Address - Street 1:2550 SHATTUCK AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2724
Practice Address - Country:US
Practice Address - Phone:510-422-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19172171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist