Provider Demographics
NPI:1457616385
Name:OH, HYUN SIK (DDS)
Entity Type:Individual
Prefix:DR
First Name:HYUN
Middle Name:SIK
Last Name:OH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 POMEROON ST APT 107
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-4891
Mailing Address - Country:US
Mailing Address - Phone:213-804-3616
Mailing Address - Fax:
Practice Address - Street 1:1211 DOLPHIN CT
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1488
Practice Address - Country:US
Practice Address - Phone:262-436-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190291671223G0001X
WI71871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice