Jessica Ahn, DMD
Individual provider Active NPI Dentist · Covington, WA
NPI 1275966178 · NPPES record last updated Aug 14, 2013
Key facts
- NPI
- 1275966178
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DE60399470 (WA)
- Practice address
- 17265 SE Wax Rd Ste 101
Covington, WA 98042-9102 - Phone
- (253) 639-6868
- NPI assigned
- Aug 14, 2013
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150921003156 | WA | Order and Referring Only - Dentist |
5294042404 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE60399470 | WA | Yes |
Addresses
Primary practice location
17265 SE Wax Rd Ste 101
Covington, WA 98042-9102
Mailing address
17265 SE Wax Rd Ste 101
Covington, WA 98042-9102
Other providers in Covington, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.