Provider Demographics
NPI:1265973689
Name:HO, DEREK
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:HO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3606
Mailing Address - Country:US
Mailing Address - Phone:626-513-2619
Mailing Address - Fax:626-313-3049
Practice Address - Street 1:115 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3606
Practice Address - Country:US
Practice Address - Phone:626-513-2619
Practice Address - Fax:626-313-3049
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA171259207N00000X, 207NS0135X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology