Provider Demographics
NPI:1336562545
Name:OK, VIDETH
Entity Type:Individual
Prefix:
First Name:VIDETH
Middle Name:
Last Name:OK
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 1:1088 S LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-6905
Mailing Address - Country:US
Mailing Address - Phone:562-218-9530
Mailing Address - Fax:562-200-8790
Practice Address - Street 1:1900 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-5502
Practice Address - Country:US
Practice Address - Phone:562-218-9530
Practice Address - Fax:562-200-8790
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)