Provider Demographics
NPI:1255638284
Name:SAEKYU OH DMD DENTAL CORP
Entity type:Organization
Organization Name:SAEKYU OH DMD DENTAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAEKYU
Authorized Official - Middle Name:
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:661-328-1527
Mailing Address - Street 1:3990 MING AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-5005
Mailing Address - Country:US
Mailing Address - Phone:661-323-1111
Mailing Address - Fax:661-328-1515
Practice Address - Street 1:3990 MING AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-5005
Practice Address - Country:US
Practice Address - Phone:661-323-1111
Practice Address - Fax:661-328-1515
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAEKYU OH DMD DENTAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-28
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92452OtherMEDICAL