Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 058130 | NY |
N | 122300000X | Dentist | 22DI02550500 | NJ |
Y | 1223P0700X | Prosthodontist | 058130 | NY |
NPI | 1194101527 |
---|---|
Provider Name | Dr. Jin Sub Oh |
First Address | Mount Kisco, NY 10549-3028 |
Second Address | Mount Kisco, NY 10549-3028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2015 |
Last Update Date | 08/11/2016 |