Provider Demographics
NPI:1083748669
Name:OH, GI MIN (LAC)
Entity Type:Individual
Prefix:MS
First Name:GI MIN
Middle Name:
Last Name:OH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 SARISSA DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-7728
Mailing Address - Country:US
Mailing Address - Phone:715-297-7795
Mailing Address - Fax:
Practice Address - Street 1:500 N 3RD ST STE 208-1
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4885
Practice Address - Country:US
Practice Address - Phone:715-297-7795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI887-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist