MEDICARE: JENNIFER SUEYUN ROH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	56235	CT
2	207P00000X	Emergency Medicine Physician	A149256	CA

General Provider Information

NPI Number	:	1639517675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SUEYUN ROH M.D.

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:	203-688-4242
Fax Number	:

Provider Business Practice Location Address
First Line	:	757 WESTWOOD PLZ STE 1517
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-3220
Country	:	US
Telephone Number	:	310-825-2111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2013
Last Update Date	:	07/21/2022

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