Basic Information
Provider Information
NPI: 1003144718
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OH
FirstName: MARISA
MiddleName: DANBEE
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1107 W DUARTE RD
Address2: UNIT B
City: ARCADIA
State: CA
PostalCode: 910077769
CountryCode: US
TelephoneNumber: 6262410704
FaxNumber:  
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
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/18/2009
LastUpdateDate: 11/18/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X20A11041CAY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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