Provider Demographics
NPI:1689860785
Name:ROH, JEONGHO (DC)
Entity Type:Individual
Prefix:DR
First Name:JEONGHO
Middle Name:
Last Name:ROH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18726 S WESTERN AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3813
Mailing Address - Country:US
Mailing Address - Phone:310-218-7634
Mailing Address - Fax:310-400-3059
Practice Address - Street 1:18726 S WESTERN AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3813
Practice Address - Country:US
Practice Address - Phone:310-218-7634
Practice Address - Fax:310-400-3059
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC25267OtherSTATE LICENSE