Provider Demographics
NPI:1285047886
Name:KOH, DONGWUK
Entity type:Individual
Prefix:
First Name:DONGWUK
Middle Name:
Last Name:KOH
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 1:4790 IRVINE BLVD STE 105-180
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1973
Mailing Address - Country:US
Mailing Address - Phone:562-677-5541
Mailing Address - Fax:562-202-5154
Practice Address - Street 1:4790 IRVINE BLVD SUIT 105-180
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620
Practice Address - Country:US
Practice Address - Phone:562-677-5541
Practice Address - Fax:562-202-5154
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA195239156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician