Provider Demographics
NPI:1861090664
Name:AHN, EUN K (LCSW)
Entity type:Individual
Prefix:MS
First Name:EUN
Middle Name:K
Last Name:AHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 FARRINGTON HWY # 524-256
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2009
Mailing Address - Country:US
Mailing Address - Phone:917-640-6917
Mailing Address - Fax:
Practice Address - Street 1:590 FARRINGTON HWY # 524-256
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2009
Practice Address - Country:US
Practice Address - Phone:917-640-6917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0754141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical