Provider Demographics
NPI:1619035870
Name:KOH, HEEJUNG (OD)
Entity Type:Individual
Prefix:DR
First Name:HEEJUNG
Middle Name:
Last Name:KOH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18337 COLIMA RD
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2762
Mailing Address - Country:US
Mailing Address - Phone:626-854-1131
Mailing Address - Fax:
Practice Address - Street 1:18337 COLIMA RD
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2762
Practice Address - Country:US
Practice Address - Phone:626-854-1131
Practice Address - Fax:626-854-1727
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12818 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0128180Medicaid
CASD0128180Medicaid
CAWOP12818BMedicare PIN