Provider Demographics
NPI:1477175263
Name:NOH, ESTAR SIEUN (PHN, BSN, RN)
Entity Type:Individual
Prefix:
First Name:ESTAR
Middle Name:SIEUN
Last Name:NOH
Suffix:
Gender:F
Credentials:PHN, BSN, RN
Other - Prefix:
Other - First Name:CI-EUN
Other - Middle Name:
Other - Last Name:NOH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3851 ROSECRANS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3115
Mailing Address - Country:US
Mailing Address - Phone:619-531-5800
Mailing Address - Fax:619-542-4186
Practice Address - Street 1:3851 ROSECRANS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-531-5800
Practice Address - Fax:619-542-4186
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2021-05-12
Deactivation Date:2020-08-29
Deactivation Code:
Reactivation Date:2021-04-19
Provider Licenses
StateLicense IDTaxonomies
CARN95208631163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse