Provider Demographics
NPI:1295886919
Name:KOH, JOSEPH CHANG (LAC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CHANG
Last Name:KOH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:DR
Other - First Name:CHANG
Other - Middle Name:WOO
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:28212 KELLY JOHNSON PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5084
Mailing Address - Country:US
Mailing Address - Phone:661-257-1233
Mailing Address - Fax:
Practice Address - Street 1:28212 KELLY JOHNSON PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5084
Practice Address - Country:US
Practice Address - Phone:661-257-1233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 8095171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist