Provider Demographics
NPI:1649236191
Name:OH, SIMON CHIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:CHIN
Last Name:OH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-481-0030
Mailing Address - Fax:720-748-0503
Practice Address - Street 1:1444 S. POTOMAC ST
Practice Address - Street 2:#280
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4509
Practice Address - Country:US
Practice Address - Phone:303-481-0030
Practice Address - Fax:720-748-0503
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO492922084N0400X
WI490362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87923271Medicaid
WI35297800Medicaid
COP01000034Medicare PIN
CO87923271Medicaid