Provider Demographics
NPI:1841965795
Name:ROH, JAE HO
Entity type:Individual
Prefix:
First Name:JAE HO
Middle Name:
Last Name:ROH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 ORMONDE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-3114
Mailing Address - Country:US
Mailing Address - Phone:408-761-4312
Mailing Address - Fax:
Practice Address - Street 1:333 COBALT WAY STE 101
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-5404
Practice Address - Country:US
Practice Address - Phone:408-761-4312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor