Provider Demographics
NPI:1275045965
Name:OH, KYUNG (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:KYUNG
Middle Name:
Last Name:OH
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 COLUMBUS PKWY
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-5402
Mailing Address - Country:US
Mailing Address - Phone:707-747-3453
Mailing Address - Fax:
Practice Address - Street 1:713 SPOKANE AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1710
Practice Address - Country:US
Practice Address - Phone:716-908-2036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty