Provider Demographics
NPI:1578527651
Name:OH, SUN WOONG (MD)
Entity Type:Individual
Prefix:DR
First Name:SUN
Middle Name:WOONG
Last Name:OH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:201 OCEAN AVE
Mailing Address - Street 2:UNIT 1605P
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-1415
Mailing Address - Country:US
Mailing Address - Phone:410-370-0154
Mailing Address - Fax:
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6098
Practice Address - Country:US
Practice Address - Phone:213-413-3000
Practice Address - Fax:323-666-2939
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53641207L00000X
MDD0020653207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD303771100Medicaid
MDD72074Medicare UPIN
CACB273890 (HP ANES)Medicare PIN