Healthcare Provider Details

I. General information

NPI: 1043296866
Provider Name (Legal Business Name): PILSOO OH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S VIRGIL AVE SUITE 202
LOS ANGELES CA
90020-1416
US

IV. Provider business mailing address

520 S. VIRGIL AVE. SUITE 202
LOS ANGELES CA
90020
US

V. Phone/Fax

Practice location:
  • Phone: 213-368-0360
  • Fax: 213-368-0976
Mailing address:
  • Phone: 213-368-0360
  • Fax: 213-368-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number217683
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA100119
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number227789
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: