Provider Demographics
NPI:1578063194
Name:OH, INAE
Entity Type:Individual
Prefix:
First Name:INAE
Middle Name:
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 1:2717 W OLYMPIC BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2642
Mailing Address - Country:US
Mailing Address - Phone:213-361-5929
Mailing Address - Fax:213-263-2051
Practice Address - Street 1:2717 W OLYMPIC BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2642
Practice Address - Country:US
Practice Address - Phone:213-361-5929
Practice Address - Fax:213-263-2051
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist