Healthcare Provider Details

I. General information

NPI: 1619437985
Provider Name (Legal Business Name): EDWARD OH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 W THUNDERBIRD RD STE E151
GLENDALE AZ
85306-4685
US

IV. Provider business mailing address

5757 W THUNDERBIRD RD STE E151
GLENDALE AZ
85306-4685
US

V. Phone/Fax

Practice location:
  • Phone: 602-865-4570
  • Fax: 602-865-4575
Mailing address:
  • Phone: 602-865-4570
  • Fax: 602-865-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number80752
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: