MEDICARE: SOOYONG ROH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC10186	CA

General Provider Information

NPI Number	:	1407011232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOOYONG ROH

Provider Business Mailing Address
First Line	:	903 CRENSHAW BLVD STE 206B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-1966
Country	:	US
Telephone Number	:	213-820-1040
Fax Number	:

Provider Business Practice Location Address
First Line	:	903 CRENSHAW BLVD STE 206B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-1966
Country	:	US
Telephone Number	:	213-820-1040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	12/06/2019

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Directions to “ SOOYONG ROH ” Practice Location

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