Provider Demographics
NPI:1003927724
Name:OHM, DONG WHA (MD)
Entity Type:Individual
Prefix:DR
First Name:DONG
Middle Name:WHA
Last Name:OHM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4040
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-0040
Mailing Address - Country:US
Mailing Address - Phone:810-875-9001
Mailing Address - Fax:810-875-9001
Practice Address - Street 1:1085 S LINDEN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3421
Practice Address - Country:US
Practice Address - Phone:810-262-2008
Practice Address - Fax:810-230-3366
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034889174400000X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3207650Medicaid
MI0255780Medicare ID - Type Unspecified