Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD-032826L | PA |
NPI | 1093745549 |
---|---|
Provider Name | Dr. Sung Kyu Henry Oh |
First Address | Radnor, PA 19087-2803 |
Second Address | Philadelphia, PA 19145-2303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0052854000 | KEYSTONE HP EAST PROVIDER (01) | PA |
0615534 | (05) | PA |
2049009000 | KEYSTONE HP EAST PRACTICE (01) | PA |
2665885 | AETNA HMO PROVIDER # (01) | PA |
5523080 | AETNA PPO PROVIDER # (01) | PA |
6204959B | CIGNA PROVIDER # (01) | PA |
D71438 | (02) | PA |