Provider Demographics
NPI:1396385266
Name:NOH, JASON DONGHYUK (LAC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DONGHYUK
Last Name:NOH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S LA FAYETTE PARK PL APT 411
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1650
Mailing Address - Country:US
Mailing Address - Phone:213-700-2242
Mailing Address - Fax:
Practice Address - Street 1:3003 W OLYMPIC BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-6511
Practice Address - Country:US
Practice Address - Phone:213-700-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17634171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist