Healthcare Provider Details

I. General information

NPI: 1447871447
Provider Name (Legal Business Name): MOO JIN OH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5465 SW 34TH ST
GAINESVILLE FL
32608-5032
US

IV. Provider business mailing address

5465 SW 34TH ST
GAINESVILLE FL
32608-5032
US

V. Phone/Fax

Practice location:
  • Phone: 352-384-3560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number341023
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1021996
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: