Provider Demographics
NPI:1528186418
Name:OH, TAEJONG (DC)
Entity Type:Individual
Prefix:DR
First Name:TAEJONG
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8381 OLD COURTHOUSE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:TYSONS CORNER
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3830
Mailing Address - Country:US
Mailing Address - Phone:703-257-8111
Mailing Address - Fax:
Practice Address - Street 1:8381 OLD COURTHOUSE RD STE 150
Practice Address - Street 2:
Practice Address - City:TYSONS CORNER
Practice Address - State:VA
Practice Address - Zip Code:22182-3830
Practice Address - Country:US
Practice Address - Phone:703-257-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA104000512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG771-0001OtherBCBS
VAG00795Medicare ID - Type UnspecifiedMEDICARE NUMBER
VAG771-0001OtherBCBS