Provider Demographics
NPI:1376290783
Name:OH, KYONGSOCK (DC)
Entity Type:Individual
Prefix:DR
First Name:KYONGSOCK
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2395 TECH DR STE 3
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3277
Mailing Address - Country:US
Mailing Address - Phone:630-296-7428
Mailing Address - Fax:563-359-0926
Practice Address - Street 1:2395 TECH DR STE 3
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3277
Practice Address - Country:US
Practice Address - Phone:630-296-7428
Practice Address - Fax:563-359-0926
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-05
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA113035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty