Provider Demographics
NPI:1114009768
Name:SUN YOUNG OH
Entity type:Organization
Organization Name:SUN YOUNG OH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUN YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:CFOM0607, CFTS0158
Authorized Official - Phone:562-924-3626
Mailing Address - Street 1:18183 PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-3906
Mailing Address - Country:US
Mailing Address - Phone:562-924-3626
Mailing Address - Fax:562-924-3738
Practice Address - Street 1:18183 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-3906
Practice Address - Country:US
Practice Address - Phone:562-924-3626
Practice Address - Fax:562-924-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5878340001Medicare NSC