Provider Demographics
NPI:1245296573
Name:OH, JONG GIL (MD)
Entity type:Individual
Prefix:
First Name:JONG
Middle Name:GIL
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 1:52 PECK RD
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6107
Mailing Address - Country:US
Mailing Address - Phone:860-489-6899
Mailing Address - Fax:890-489-1206
Practice Address - Street 1:4 FARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2573
Practice Address - Country:US
Practice Address - Phone:860-284-5200
Practice Address - Fax:860-284-5333
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT045845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1245296573Medicaid
CT1245296573Medicaid