Provider Demographics
NPI:1992054530
Name:OH, MIN CHUL (LAC)
Entity type:Individual
Prefix:
First Name:MIN
Middle Name:CHUL
Last Name:OH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4433 S ALAMEDA ST
Mailing Address - Street 2:A-56B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90058-2008
Mailing Address - Country:US
Mailing Address - Phone:818-571-1586
Mailing Address - Fax:
Practice Address - Street 1:4433 S ALAMEDA ST
Practice Address - Street 2:A-56B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90058-2008
Practice Address - Country:US
Practice Address - Phone:818-571-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13315171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist