Provider Demographics
NPI:1154442945
Name:RHO, BENJAMIN BONG HO (LIAC OMD PHD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:BONG HO
Last Name:RHO
Suffix:
Gender:M
Credentials:LIAC OMD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5001 WILSHIRE BLVD
Mailing Address - Street 2:#205
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036
Mailing Address - Country:US
Mailing Address - Phone:323-931-3663
Mailing Address - Fax:323-931-1590
Practice Address - Street 1:5001 WILSHIRE BLVD
Practice Address - Street 2:#205
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036
Practice Address - Country:US
Practice Address - Phone:323-931-3663
Practice Address - Fax:323-931-1590
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2794171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6681612Medicaid