Provider Demographics
NPI:1093745549
Name:OH, SUNG KYU HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNG KYU
Middle Name:HENRY
Last Name:OH
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 1:717 HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2803
Mailing Address - Country:US
Mailing Address - Phone:610-688-9012
Mailing Address - Fax:
Practice Address - Street 1:1820 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2303
Practice Address - Country:US
Practice Address - Phone:215-468-7722
Practice Address - Fax:215-468-7729
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-032826L207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2049009000OtherKEYSTONE HP EAST PRACTICE
PA6204959BOtherCIGNA PROVIDER #
PA0615534Medicaid
PA5523080OtherAETNA PPO PROVIDER #
PA2665885OtherAETNA HMO PROVIDER #
PA0052854000OtherKEYSTONE HP EAST PROVIDER
PAD71438Medicare UPIN
PA10633Medicare ID - Type Unspecified