Provider Demographics
NPI:1104014471
Name:OH, EMMY LISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMY
Middle Name:LISSA
Last Name:OH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11567 CANTERWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5812
Mailing Address - Country:US
Mailing Address - Phone:253-426-6341
Mailing Address - Fax:253-759-4699
Practice Address - Street 1:11567 CANTERWOOD BLVD
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-5812
Practice Address - Country:US
Practice Address - Phone:253-426-6341
Practice Address - Fax:253-759-4699
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60069044207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2002545Medicaid