Healthcare Provider Details

I. General information

NPI: 1881221968
Provider Name (Legal Business Name): ANGELA JINSOOK OH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 BROOKHURST ST STE 6400
FOUNTAIN VALLEY CA
92708-6728
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 714-963-1444
  • Fax: 714-963-1234
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA190600
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberA190600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: