Healthcare Provider Details

I. General information

NPI: 1689633794
Provider Name (Legal Business Name): PAUL YOUNGBOK OH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2544 COURT DR STE G
GASTONIA NC
28054-3450
US

IV. Provider business mailing address

2544 COURT DR STE G
GASTONIA NC
28054-3450
US

V. Phone/Fax

Practice location:
  • Phone: 704-854-9990
  • Fax: 704-854-9045
Mailing address:
  • Phone: 704-854-9990
  • Fax: 704-854-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01054173A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2010-00244
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: