Provider Demographics
NPI:1770892168
Name:OH, MINKYUNG (LAC)
Entity type:Individual
Prefix:
First Name:MINKYUNG
Middle Name:
Last Name:OH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S ST ANDREWS PL APT 335
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5034
Mailing Address - Country:US
Mailing Address - Phone:213-270-4303
Mailing Address - Fax:
Practice Address - Street 1:122 S ST ANDREWS PL APT 335
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5034
Practice Address - Country:US
Practice Address - Phone:213-270-4303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13392171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC13392OtherCA ACUPUNCTURE BOARD