Provider Demographics
NPI:1558978254
Name:OH, DANIEL JIMYONG
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JIMYONG
Last Name:OH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 S HOOVER ST APT 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1932
Mailing Address - Country:US
Mailing Address - Phone:213-505-3862
Mailing Address - Fax:
Practice Address - Street 1:947 S HOOVER ST APT 203
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-1932
Practice Address - Country:US
Practice Address - Phone:213-505-3862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist