Provider Demographics
NPI:1871753582
Name:OH, YOUNG SHIG (L AC)
Entity type:Individual
Prefix:MR
First Name:YOUNG
Middle Name:SHIG
Last Name:OH
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:MR
Other - First Name:YOUNG
Other - Middle Name:SHIG
Other - Last Name:O
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6540 LUSK BLVD
Mailing Address - Street 2:SUITE C-144
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-5790
Mailing Address - Country:US
Mailing Address - Phone:858-658-9980
Mailing Address - Fax:858-658-9987
Practice Address - Street 1:6540 LUSK BLVD
Practice Address - Street 2:SUITE C-144
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-5790
Practice Address - Country:US
Practice Address - Phone:858-658-9980
Practice Address - Fax:858-658-9987
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10624171100000X
CACA10624171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist