Provider Demographics
NPI:1215380043
Name:AHN, SHIN YOUNG (DMD)
Entity type:Individual
Prefix:
First Name:SHIN YOUNG
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 ANAHEIM TER
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-5092
Mailing Address - Country:US
Mailing Address - Phone:708-800-6419
Mailing Address - Fax:
Practice Address - Street 1:505 SOUTH DR STE 5
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4210
Practice Address - Country:US
Practice Address - Phone:650-964-7866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-17
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1074951223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics