Provider Demographics
NPI:1386827178
Name:CHUNG HYUN OH MD PC
Entity Type:Organization
Organization Name:CHUNG HYUN OH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUNG
Authorized Official - Middle Name:HYUN
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-252-2752
Mailing Address - Street 1:26 SEMINARY AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2633
Mailing Address - Country:US
Mailing Address - Phone:315-252-2752
Mailing Address - Fax:315-262-6409
Practice Address - Street 1:26 SEMINARY AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2633
Practice Address - Country:US
Practice Address - Phone:315-252-2752
Practice Address - Fax:315-262-6409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111469208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00584634Medicaid
NY00584634Medicaid