MEDICARE: HEUNG SOO OH

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	171100000X	Acupuncturist	19870	CA

General Provider Information

NPI Number	:	1891567913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEUNG SOO OH

Provider Business Mailing Address
First Line	:	2317 JAMES M WOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2002
Country	:	US
Telephone Number	:	404-457-2460
Fax Number	:

Provider Business Practice Location Address
First Line	:	2317 JAMES M WOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2002
Country	:	US
Telephone Number	:	404-457-2460
Fax Number	:

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

Provider Enumeration Date	:	10/23/2023
Last Update Date	:	10/24/2023

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Directions to “ HEUNG SOO OH ” Practice Location

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