Provider Demographics
NPI:1629319462
Name:OH, CHANG HOON (L AC)
Entity Type:Individual
Prefix:MR
First Name:CHANG HOON
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2124
Mailing Address - Country:US
Mailing Address - Phone:323-733-8814
Mailing Address - Fax:323-733-8817
Practice Address - Street 1:3460 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-2124
Practice Address - Country:US
Practice Address - Phone:323-733-8814
Practice Address - Fax:323-733-8817
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9029171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist