Provider Demographics
NPI:1225106693
Name:OH, HEE YONG (MD)
Entity Type:Individual
Prefix:MR
First Name:HEE
Middle Name:YONG
Last Name:OH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:HEE
Other - Middle Name:YONG
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1433 W MERCED AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3402
Mailing Address - Country:US
Mailing Address - Phone:626-962-2421
Mailing Address - Fax:626-962-8345
Practice Address - Street 1:1433 W MERCED AVE STE 207
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3402
Practice Address - Country:US
Practice Address - Phone:626-962-2421
Practice Address - Fax:626-962-8345
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACG258Y207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA953648886OtherBLUE CROSS
CA00A343520Medicaid
CA00A343522OtherBLUE SHIELD
CA00CG258Y0Medicaid
CAE01617Medicare UPIN
CA00A343520Medicaid
CA953648886OtherBLUE CROSS