Healthcare Provider Details

I. General information

NPI: 1467904987
Provider Name (Legal Business Name): CHANGHYUN OH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7065 INDIANA AVE STE 100&110
RIVERSIDE CA
92506-4167
US

IV. Provider business mailing address

7065 INDIANA AVE STE 100&110
RIVERSIDE CA
92506-4167
US

V. Phone/Fax

Practice location:
  • Phone: 951-479-0115
  • Fax: 760-347-0909
Mailing address:
  • Phone: 951-479-0115
  • Fax: 760-347-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: