Provider Demographics
NPI:1366686867
Name:OH, SUK JOO (LIC A)
Entity Type:Individual
Prefix:DR
First Name:SUK JOO
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:LIC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 LBJ FWY # 185
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6331
Mailing Address - Country:US
Mailing Address - Phone:214-691-3210
Mailing Address - Fax:214-739-6262
Practice Address - Street 1:6200 LBJ FWY STE 185
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6565
Practice Address - Country:US
Practice Address - Phone:214-691-3210
Practice Address - Fax:214-739-6262
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX00077171100000X
TXAC00077171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist