Healthcare Provider Details

I. General information

NPI: 1205028404
Provider Name (Legal Business Name): ANNIE LEE OH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNIE LEE M.D.

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 MAGNOLIA AVE # 438
RIVERSIDE CA
92505
US

IV. Provider business mailing address

10800 MAGNOLIA AVE # 438
RIVERSIDE CA
92505-3043
US

V. Phone/Fax

Practice location:
  • Phone: 951-353-4418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036.126895
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA101541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: