Provider Demographics
NPI:1780427773
Name:OH, SIMON SUNGHWAN
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:SUNGHWAN
Last Name:OH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 UNDERWOOD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1110
Mailing Address - Country:US
Mailing Address - Phone:321-841-3500
Mailing Address - Fax:321-843-8777
Practice Address - Street 1:76 UNDERWOOD ST STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1110
Practice Address - Country:US
Practice Address - Phone:321-841-3500
Practice Address - Fax:321-843-8777
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF06241642363LF0000X
FLAPRN11033970363LA2200X
FLRN9437064163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care