Healthcare Provider Details

I. General information

NPI: 1215846647
Provider Name (Legal Business Name): NAYOUNG OH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W 1 ST, LOS BANOS, CA 93635
LOS BANOS CA
93635
US

IV. Provider business mailing address

1547 CONCERTO LN
HUGHSON CA
95326
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-4842
  • Fax:
Mailing address:
  • Phone: 208-484-3078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: