Provider Demographics
NPI:1740575398
Name:OH, JOANNE JIEUN (DDS)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:JIEUN
Last Name:OH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WEST ST
Mailing Address - Street 2:APT 31H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1217
Mailing Address - Country:US
Mailing Address - Phone:951-591-0861
Mailing Address - Fax:
Practice Address - Street 1:20 WEST ST
Practice Address - Street 2:APT 31H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1217
Practice Address - Country:US
Practice Address - Phone:951-591-0861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2016-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056372-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice