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NPI Code Detail

MEDICARE: JAEHO EOM

MEDICARE: JAEHO EOM
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
1183500000XPharmacist65787CA

General Provider Information

NPI Number : 1972961225
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAEHO EOM
Provider Business Mailing Address
First Line : 2530 GLENDALE BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90039-3220
Country : US
Telephone Number : 323-666-1285
Fax Number :
Provider Business Practice Location Address
First Line : 2530 GLENDALE BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90039-3220
Country : US
Telephone Number : 323-666-1285
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2016
Last Update Date : 02/02/2016

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Directions to “ JAEHO EOM ” Practice Location

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