Provider Demographics
NPI:1689720930
Name:OH, JEONG GUK (LAC)
Entity Type:Individual
Prefix:DR
First Name:JEONG
Middle Name:GUK
Last Name:OH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:10515 BALBOA BLVD STE 175
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6382
Mailing Address - Country:US
Mailing Address - Phone:818-368-3020
Mailing Address - Fax:818-368-3481
Practice Address - Street 1:10515 BALBOA BLVD STE 175
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6382
Practice Address - Country:US
Practice Address - Phone:818-368-3020
Practice Address - Fax:818-368-3481
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC9921171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7977836Medicare UPIN