Provider Demographics
NPI:1396922712
Name:OH, JAE YONG (DDS)
Entity type:Individual
Prefix:DR
First Name:JAE
Middle Name:YONG
Last Name:OH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2185 LEMOINE AVE STE 1M
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6030
Mailing Address - Country:US
Mailing Address - Phone:201-944-0797
Mailing Address - Fax:201-944-5080
Practice Address - Street 1:2185 LEMOINE AVE STE 1M
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6030
Practice Address - Country:US
Practice Address - Phone:201-944-0797
Practice Address - Fax:201-944-5080
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0541261223E0200X
NJ22DI02365001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics