Provider Demographics
NPI:1396062493
Name:AU, LYDIA OH (LAC)
Entity type:Individual
Prefix:MISS
First Name:LYDIA
Middle Name:OH
Last Name:AU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8011 EBBTIDE CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-5005
Mailing Address - Country:US
Mailing Address - Phone:714-900-3736
Mailing Address - Fax:
Practice Address - Street 1:202 FASHION LN STE 116
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3319
Practice Address - Country:US
Practice Address - Phone:714-798-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist