Healthcare Provider Details

I. General information

NPI: 1316454986
Provider Name (Legal Business Name): OH DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 S MOONEY BLVD
VISALIA CA
93277-4445
US

IV. Provider business mailing address

PO BOX 10059
BAKERSFIELD CA
93389-0059
US

V. Phone/Fax

Practice location:
  • Phone: 559-734-1111
  • Fax:
Mailing address:
  • Phone: 661-328-0876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number44049
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SAEKYU OH
Title or Position: CEO
Credential: DMD
Phone: 661-831-5437