=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689818866
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARION KIM WAN HO MD A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2009
-----------------------------------------------------
Last Update Date | 05/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6325 TOPANGA CANYON BLVD SUITE 315
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91367-2033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-615-2888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6325 TOPANGA CANYON BLVD SUITE 315
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91367-2033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-615-2888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARION HO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 818-615-2888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | G75129
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------