Provider Demographics
NPI:1740737543
Name:MOH, JONATHAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:MOH
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NEWPORT CENTER DR
Mailing Address - Street 2:STE 213
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7503
Mailing Address - Country:US
Mailing Address - Phone:562-923-4704
Mailing Address - Fax:562-923-6709
Practice Address - Street 1:27136 PASEO ESPADA
Practice Address - Street 2:SUITE B1103
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2728
Practice Address - Country:US
Practice Address - Phone:949-429-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16606225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist