Provider Demographics
NPI:1326474602
Name:NOH, SOO JIN (OD)
Entity Type:Individual
Prefix:DR
First Name:SOO JIN
Middle Name:
Last Name:NOH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 O ST
Mailing Address - Street 2:STE 102
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-5327
Mailing Address - Country:US
Mailing Address - Phone:916-443-3524
Mailing Address - Fax:
Practice Address - Street 1:400 O ST
Practice Address - Street 2:STE 102
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-5327
Practice Address - Country:US
Practice Address - Phone:916-443-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 14698 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist