Provider Demographics
NPI:1063531523
Name:OH, UN CHU AGNES (PSYD, LMFT)
Entity type:Individual
Prefix:DR
First Name:UN CHU
Middle Name:AGNES
Last Name:OH
Suffix:
Gender:F
Credentials:PSYD, LMFT
Other - Prefix:DR
Other - First Name:UN CHU
Other - Middle Name:AGNES
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:1010 N CENTRAL AVE # 315
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2937
Mailing Address - Country:US
Mailing Address - Phone:818-441-1096
Mailing Address - Fax:
Practice Address - Street 1:1010 N CENTRAL AVE # 315
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202
Practice Address - Country:US
Practice Address - Phone:818-441-1096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45121106H00000X
CA23845103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist