Katherine Ahn Wallace, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

41055 Issued in CA

Practice address

11121 Los Alamitos Blvd Ste 201
Los Alamitos, CA 90720-3603

Phone

(714) 230-2434

NPI assigned

Dec 5, 2006

Last updated

Jul 23, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ahn DDS, Inc.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Los Alamitos, CA
  • NPI 1932772191
  NPD Authorized official
• Huntington Surgery Center, Inc

  • Ambulatory Surgical Clinic/Center
  • Huntington Beach, CA
  • NPI 1932277886
  NPD (past)
• Katherine Ahn DDS a Dental Corporation

  • Dentist
  • Huntington Beach, CA
  • NPI 1558780494
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626998400000",
    "number": "1790843381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11121 LOS ALAMITOS BLVD STE 201",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907203603",
            "telephone_number": "714-230-2434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11121 LOS ALAMITOS BLVD STE 201",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907203603",
            "telephone_number": "714-230-2434"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7801 Center Ave",
            "address_2": "Suite 101",
            "address_purpose": "LOCATION",
            "city": "Huntington Beach",
            "state": "CA",
            "postal_code": "926479110",
            "country_code": "US",
            "telephone_number": "714-230-2400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KATHERINE",
        "middle_name": "AHN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2021-07-23",
        "certification_date": "2021-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "41055",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "41055",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "41055",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walid Faraj, D.O., a Professional Corporation
• Walid Faraj, D.O., a Professional Corporation
• Andrew Justin Walker
• Kathryn Walker, LMFT
• John Brian Wallace, DDS
• Megan Kristen Walsch
• Daniel Patrick Walsh
• Brian Wang
• Steven Brian Wasserman, D.C.
• Mary Ann Watson, OTR/L

• General Practice Dentistry in Los Alamitos, CA
• Providers in Los Alamitos, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.