Provider Demographics
NPI:1134530975
Name:KOH, HAEJA
Entity type:Individual
Prefix:
First Name:HAEJA
Middle Name:
Last Name:KOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 ALAMO DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6394
Mailing Address - Country:US
Mailing Address - Phone:707-447-2526
Mailing Address - Fax:707-446-6182
Practice Address - Street 1:3061 ALAMO DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6394
Practice Address - Country:US
Practice Address - Phone:707-447-2526
Practice Address - Fax:707-446-6182
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA44964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist