Provider Demographics
NPI:1558391672
Name:OH, EUN JOO (MD)
Entity Type:Individual
Prefix:
First Name:EUN
Middle Name:JOO
Last Name:OH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E VUELTA CAMINATA DEL RIO
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737
Mailing Address - Country:US
Mailing Address - Phone:520-547-5688
Mailing Address - Fax:520-547-4661
Practice Address - Street 1:555 E VUELTA CAMINATA DEL RIO
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737
Practice Address - Country:US
Practice Address - Phone:520-547-5688
Practice Address - Fax:520-547-4661
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41023207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ139669OtherMEDICARE PTAN