Provider Demographics
NPI:1649675273
Name:OH, DAESAN (ACUPUNTURE)
Entity type:Individual
Prefix:
First Name:DAESAN
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:ACUPUNTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 WILSHIRE BLVD STE 412
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3439
Mailing Address - Country:US
Mailing Address - Phone:213-500-7447
Mailing Address - Fax:
Practice Address - Street 1:4055 WILSHIRE BLVD STE 412
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3439
Practice Address - Country:US
Practice Address - Phone:213-500-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10875171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist