Provider Demographics
NPI:1235328683
Name:OH, GENE KYO (MD)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:KYO
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:PO BOX 775
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92842-0775
Mailing Address - Country:US
Mailing Address - Phone:714-636-0342
Mailing Address - Fax:714-636-0391
Practice Address - Street 1:12900A GARDEN GROVE BLVD
Practice Address - Street 2:122
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2023
Practice Address - Country:US
Practice Address - Phone:714-636-0342
Practice Address - Fax:714-636-0391
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26489207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A264891Medicaid
CA00A264891Medicaid
CAA83395Medicare UPIN