Provider Demographics
NPI:1457421158
Name:OH, SAM HEUNGSAM (LAC)
Entity Type:Individual
Prefix:MR
First Name:SAM
Middle Name:HEUNGSAM
Last Name:OH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:726 W BARSTOW AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-1955
Mailing Address - Country:US
Mailing Address - Phone:559-449-0355
Mailing Address - Fax:559-449-0356
Practice Address - Street 1:726 W BARSTOW AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1955
Practice Address - Country:US
Practice Address - Phone:559-449-0355
Practice Address - Fax:559-449-0356
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5782171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist