Provider Demographics
NPI:1851458145
Name:OH, YOUN KANG (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUN
Middle Name:KANG
Last Name:OH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SYLVAN AVE. SUITE 326
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2733
Mailing Address - Country:US
Mailing Address - Phone:908-246-9586
Mailing Address - Fax:201-408-4347
Practice Address - Street 1:333 SYLVAN AVE. SUITE 326
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2733
Practice Address - Country:US
Practice Address - Phone:908-246-9586
Practice Address - Fax:201-408-4347
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA032844002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4960807Medicaid
NJ567674AJBMedicare PIN
NJ567674CFOMedicare PIN
C54094Medicare UPIN