Provider Demographics
NPI:1558559401
Name:OH, JOOYOUNG
Entity Type:Individual
Prefix:DR
First Name:JOOYOUNG
Middle Name:
Last Name:OH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 LAKE PARK DR SE
Mailing Address - Street 2:APT. T
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7603
Mailing Address - Country:US
Mailing Address - Phone:800-417-4444
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:678 N WILSON WAY
Practice Address - Street 2:#D
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-4272
Practice Address - Country:US
Practice Address - Phone:209-937-9000
Practice Address - Fax:209-939-1649
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55575122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD55575Medicaid