Provider Demographics
NPI:1154455244
Name:OH, KYU (ORTHOTIST)
Entity Type:Individual
Prefix:
First Name:KYU
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 INLAND EMPIRE BLVD STE C130
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4942
Mailing Address - Country:US
Mailing Address - Phone:909-484-5700
Mailing Address - Fax:909-484-5700
Practice Address - Street 1:3602 INLAND EMPIRE BLVD STE C130
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4942
Practice Address - Country:US
Practice Address - Phone:909-484-5700
Practice Address - Fax:909-484-5700
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACO3327222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist