Provider Demographics
NPI:1801433131
Name:OH, JONG S (BSN, RN)
Entity type:Individual
Prefix:
First Name:JONG
Middle Name:S
Last Name:OH
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12844 MILITARY RD S
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-3045
Mailing Address - Country:US
Mailing Address - Phone:206-782-2700
Mailing Address - Fax:
Practice Address - Street 1:12844 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3045
Practice Address - Country:US
Practice Address - Phone:206-237-0087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61188066363LP0808X
WAEP61191131363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health