Basic Information
| Provider Information | |||||||||
| NPI: | 1790113710 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | AHN | ||||||||
| FirstName: | JINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 W ELIZABETH ST APT 142 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805215015 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | AYLESWORTH HALL NW 800 MERIDIAN DR | ||||||||
| Address2: | COLORADO STATE UNIVERSITY | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805230001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704916053 | ||||||||
| FaxNumber: | 9704912382 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2013 | ||||||||
| LastUpdateDate: | 10/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.