Provider Demographics
NPI:1407807944
Name:OH, DONG-JOON C (MD, NCCA CERTIFED)
Entity Type:Individual
Prefix:
First Name:DONG-JOON
Middle Name:C
Last Name:OH
Suffix:
Gender:M
Credentials:MD, NCCA CERTIFED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 W CHELTENHAM AVE STE 201B
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3141
Mailing Address - Country:US
Mailing Address - Phone:215-909-9907
Mailing Address - Fax:
Practice Address - Street 1:1349 W CHELTENHAM AVE STE 201B
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3141
Practice Address - Country:US
Practice Address - Phone:215-909-9907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027929E207L00000X
PAAK000107L171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009156100009Medicaid
PAB38067Medicare UPIN
PA134185PFEMedicare PIN