Provider Demographics
NPI:1992989024
Name:NOH, JAE MIN (LAC)
Entity type:Individual
Prefix:
First Name:JAE MIN
Middle Name:
Last Name:NOH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:11752 GARDEN GROVE BLVD
Mailing Address - Street 2:#116
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1423
Mailing Address - Country:US
Mailing Address - Phone:714-534-0603
Mailing Address - Fax:714-534-0603
Practice Address - Street 1:11752 GARDEN GROVE BLVD
Practice Address - Street 2:#116
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1423
Practice Address - Country:US
Practice Address - Phone:714-534-0603
Practice Address - Fax:714-534-0603
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2009-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA11905171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist