Healthcare Provider Details

I. General information

NPI: 1730884727
Provider Name (Legal Business Name): SANGKYU NOH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 SYCAMORE DR
SIMI VALLEY CA
93065-1201
US

IV. Provider business mailing address

2975 SYCAMORE DR
SIMI VALLEY CA
93065-1201
US

V. Phone/Fax

Practice location:
  • Phone: 805-955-6000
  • Fax:
Mailing address:
  • Phone: 805-955-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A25309
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR4156
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: