Provider Demographics
NPI:1194535609
Name:EOM, TAE OOK
Entity type:Individual
Prefix:MR
First Name:TAE
Middle Name:OOK
Last Name:EOM
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 1:20 TRUMAN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-5756
Mailing Address - Country:US
Mailing Address - Phone:949-400-5878
Mailing Address - Fax:
Practice Address - Street 1:20 TRUMAN ST STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-5756
Practice Address - Country:US
Practice Address - Phone:949-400-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker