Healthcare Provider Details

I. General information

NPI: 1063531523
Provider Name (Legal Business Name): UN CHU AGNES OH PSY.D., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: UN CHU AGNES OH PSY.D.

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N CENTRAL AVE # 315
GLENDALE CA
91202
US

IV. Provider business mailing address

1010 N CENTRAL AVE # 315
GLENDALE CA
91202-2937
US

V. Phone/Fax

Practice location:
  • Phone: 818-441-1096
  • Fax:
Mailing address:
  • Phone: 818-441-1096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number23845
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number45121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: