Provider Demographics
NPI:1518416262
Name:OH, MEESUK CHO
Entity Type:Individual
Prefix:
First Name:MEESUK
Middle Name:CHO
Last Name:OH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 BROOKE LN
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-1245
Mailing Address - Country:US
Mailing Address - Phone:213-258-8292
Mailing Address - Fax:
Practice Address - Street 1:1440 S ANAHEIM BLVD
Practice Address - Street 2:G1
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6213
Practice Address - Country:US
Practice Address - Phone:714-340-6590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist