Provider Demographics
NPI:1316214802
Name:OAK, TAE HOON (LAC)
Entity Type:Individual
Prefix:
First Name:TAE HOON
Middle Name:
Last Name:OAK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:TAEHOON
Other - Middle Name:
Other - Last Name:OAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:5047 HANOVER CIR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3652
Mailing Address - Country:US
Mailing Address - Phone:213-435-1952
Mailing Address - Fax:
Practice Address - Street 1:13151 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1079
Practice Address - Country:US
Practice Address - Phone:714-539-1300
Practice Address - Fax:714-539-1302
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6907171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist