Provider Demographics
NPI:1740406180
Name:OH, SE YEONG (OMD)
Entity Type:Individual
Prefix:
First Name:SE YEONG
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2012 BROOKE LANE
Mailing Address - Street 2:
Mailing Address - City:FLULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833
Mailing Address - Country:US
Mailing Address - Phone:714-340-6590
Mailing Address - Fax:714-236-9097
Practice Address - Street 1:2015 W REDONDO BEACH BLVD STE F
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3642
Practice Address - Country:US
Practice Address - Phone:424-340-9357
Practice Address - Fax:424-340-9357
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10176171100000X
CA10176171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist