Provider Demographics
NPI:1497159941
Name:ROH, KWANGHO CALEB (DC)
Entity Type:Individual
Prefix:
First Name:KWANGHO
Middle Name:CALEB
Last Name:ROH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16911 HIGHWAY 99 STE 105
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3104
Mailing Address - Country:US
Mailing Address - Phone:425-588-3838
Mailing Address - Fax:425-588-3800
Practice Address - Street 1:16911 HIGHWAY 99 STE 105
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-3104
Practice Address - Country:US
Practice Address - Phone:425-588-3838
Practice Address - Fax:425-588-3800
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61446291171100000X
WACH60498261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist