Provider Demographics
NPI:1831520139
Name:OH, SEI IL (LAC)
Entity type:Individual
Prefix:
First Name:SEI
Middle Name:IL
Last Name:OH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:SEIIL
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:973 FOOTHILL DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-5302
Mailing Address - Country:US
Mailing Address - Phone:408-315-0726
Mailing Address - Fax:
Practice Address - Street 1:973 FOOTHILL DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-5302
Practice Address - Country:US
Practice Address - Phone:408-315-0726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15654171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist