Provider Demographics
NPI:1871810648
Name:OH, JOON S (LAC)
Entity type:Individual
Prefix:
First Name:JOON
Middle Name:S
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 1:5712 5TH AVE
Mailing Address - Street 2:2ND FL.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3816
Mailing Address - Country:US
Mailing Address - Phone:917-509-5622
Mailing Address - Fax:
Practice Address - Street 1:5712 5TH AVE
Practice Address - Street 2:2ND FL.
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3816
Practice Address - Country:US
Practice Address - Phone:917-509-5622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003243-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist