MEDICARE: DR. SUNG KYU HENRY OH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	MD-032826L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2049009000	OTHER	PA	KEYSTONE HP EAST PRACTICE
2	6204959B	OTHER	PA	CIGNA PROVIDER #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	5523080	OTHER	PA	AETNA PPO PROVIDER #
5	2665885	OTHER	PA	AETNA HMO PROVIDER #
6	0052854000	OTHER	PA	KEYSTONE HP EAST PROVIDER

General Provider Information

NPI Number	:	1093745549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUNG KYU HENRY OH M.D.

Provider Business Mailing Address
First Line	:	717 HOLLOW RD
Second Line	:
City	:	RADNOR
State	:	PA
Zip	:	19087-2803
Country	:	US
Telephone Number	:	610-688-9012
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-2303
Country	:	US
Telephone Number	:	215-468-7722
Fax Number	:	215-468-7729

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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