Healthcare Provider Details

I. General information

NPI: 1972330835
Provider Name (Legal Business Name): KYUCHUL OH DDS, MSD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KEITETSU KURE DDS, MSD, PHD

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 CUMING ST
OMAHA NE
68102-4325
US

IV. Provider business mailing address

2109 CUMING ST RM 130A
OMAHA NE
68102-4325
US

V. Phone/Fax

Practice location:
  • Phone: 402-280-5065
  • Fax:
Mailing address:
  • Phone: 402-280-5065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number146
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: