Individual provider Active NPI

Sooyong Roh

  • Acupuncturist
  • Los Angeles, CA
National Provider Identifier
1407011232
Registry record updated Dec 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
AC10186 Issued in CA
Practice address
903 Crenshaw Blvd Ste 206B
Los Angeles, CA 90019-1966
Phone
(213) 820-1040
NPI assigned
Jul 21, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X AC10186 CA Primary

Addresses

Primary practice location

903 Crenshaw Blvd Ste 206B
Los Angeles, CA 90019-1966

Mailing address

903 Crenshaw Blvd Ste 206B
Los Angeles, CA 90019-1966
Phone (213) 820-1040

Other practice location 1

2017 W Olympic Blvd
Los Angeles, CA 90006-3705
Phone (213) 480-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
AC10186CAMDAcupuncturist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575590400000",
    "number": "1407011232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 CRENSHAW BLVD STE 206B",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900191966",
            "telephone_number": "213-820-1040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 CRENSHAW BLVD STE 206B",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900191966",
            "telephone_number": "213-820-1040"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2017 W Olympic Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900063705",
            "country_code": "US",
            "telephone_number": "213-480-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROH",
        "first_name": "SOOYONG",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-21",
        "last_updated": "2019-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "AC10186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.