Provider Demographics
NPI:1336120088
Name:OK, JOON-HA (MD)
Entity Type:Individual
Prefix:MR
First Name:JOON-HA
Middle Name:
Last Name:OK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:PHYSICIAN SUPPORT SERVICES
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2948
Mailing Address - Fax:916-858-7065
Practice Address - Street 1:8220 WYMARK DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757
Practice Address - Country:US
Practice Address - Phone:916-667-0600
Practice Address - Fax:916-683-0232
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2014-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301099637208800000X
CAA98957208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2051157Medicare UPIN