Provider Demographics
NPI:1508884859
Name:OH, ANDREW KIM (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:KIM
Last Name:OH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:700 SUNSET DR
Mailing Address - Street 2:STE A
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-1260
Mailing Address - Country:US
Mailing Address - Phone:541-963-1919
Mailing Address - Fax:
Practice Address - Street 1:7551 MADISON AVE
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7449
Practice Address - Country:US
Practice Address - Phone:916-904-3000
Practice Address - Fax:916-863-2966
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD2051892084N0400X
CAA609272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A609270Medicaid
CAG94218Medicare UPIN
CAAP296ZMedicare Oscar/Certification