Provider Demographics
NPI:1760828776
Name:JEONG-HO ROH DDS INC
Entity Type:Organization
Organization Name:JEONG-HO ROH DDS INC
Other - Org Name:LA BREA FAMILY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEONG-HO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-734-2284
Mailing Address - Street 1:3400 S LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-5217
Mailing Address - Country:US
Mailing Address - Phone:323-734-2284
Mailing Address - Fax:323-734-3178
Practice Address - Street 1:3400 S LA BREA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-5217
Practice Address - Country:US
Practice Address - Phone:323-734-2284
Practice Address - Fax:323-734-3178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty