Healthcare Provider Details

I. General information

NPI: 1356652101
Provider Name (Legal Business Name): JOSEPH HYUNSEOG OH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2010
Last Update Date: 11/23/2021
Certification Date: 11/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W 6TH ST STE 120
LOS ANGELES CA
90017-1823
US

IV. Provider business mailing address

24043 DEARBORN DR
VALENCIA CA
91354-1869
US

V. Phone/Fax

Practice location:
  • Phone: 213-935-8401
  • Fax: 213-935-8403
Mailing address:
  • Phone: 323-636-3080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18254
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 60356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: