Basic Information
| Provider Information | |||||||||
| NPI: | 1619163870 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GOH | ||||||||
| FirstName: | IAN | ||||||||
| MiddleName: | CHWEN HSIEN | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8550 COSTA VERDE BLVD | ||||||||
| Address2: | APT 5418 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921221177 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3130 BONITA RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919103263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195857104 | ||||||||
| FaxNumber: | 6195857106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2007 | ||||||||
| LastUpdateDate: | 09/21/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT9271 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XE1200X | OT9271 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Ergonomics | 225XH1200X | OT9271 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No ID Information.