Provider Demographics
NPI:1386228211
Name:SAEKYU OH DMD DENTAL CORP
Entity Type:Organization
Organization Name:SAEKYU OH DMD DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAEKYU
Authorized Official - Middle Name:
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:661-328-0876
Mailing Address - Street 1:PO BOX 10059
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-0059
Mailing Address - Country:US
Mailing Address - Phone:661-328-0876
Mailing Address - Fax:
Practice Address - Street 1:3790 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-5306
Practice Address - Country:US
Practice Address - Phone:800-400-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty