Basic Information
| Provider Information | |||||||||
| NPI: | 1003144718 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OH | ||||||||
| FirstName: | MARISA | ||||||||
| MiddleName: | DANBEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1107 W DUARTE RD | ||||||||
| Address2: | UNIT B | ||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910077769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262410704 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2020 ZONAL AVE | ||||||||
| Address2: | LAC-USC MED CTR- INTERNS/RESIDENTS BUILDING, ROOM 112 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900890121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262410704 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2009 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 20A11041 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.