Provider Demographics
NPI:1417651530
Name:OH, CLARA JEONGMIN
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:JEONGMIN
Last Name:OH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEONG MIN
Other - Middle Name:
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:813 E GREEN MEADOWS RD APT 209
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-3739
Mailing Address - Country:US
Mailing Address - Phone:314-914-7707
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-5215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program