Provider Demographics
NPI:1164826392
Name:OH, SUNGHYE N/A (LC4021)
Entity Type:Individual
Prefix:
First Name:SUNGHYE
Middle Name:N/A
Last Name:OH
Suffix:
Gender:F
Credentials:LC4021
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 AVONSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6712
Mailing Address - Country:US
Mailing Address - Phone:240-704-9921
Mailing Address - Fax:240-331-0307
Practice Address - Street 1:36 AVONSHIRE CT
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-6712
Practice Address - Country:US
Practice Address - Phone:240-704-9921
Practice Address - Fax:240-331-0307
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4021101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD085382800Medicaid