Provider Demographics
NPI:1629735899
Name:OH, KYUNG SUK (ATC)
Entity Type:Individual
Prefix:
First Name:KYUNG SUK
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 WAHOO WAY APT 732
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4161
Mailing Address - Country:US
Mailing Address - Phone:434-996-5393
Mailing Address - Fax:
Practice Address - Street 1:111 MONTICELLO AVE STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5698
Practice Address - Country:US
Practice Address - Phone:434-996-5393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260036592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer