Healthcare Provider Details

I. General information

NPI: 1851458145
Provider Name (Legal Business Name): YOUN KANG OH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SYLVAN AVE. SUITE 326
ENGLEWOOD CLIFFS NJ
07632-2733
US

IV. Provider business mailing address

333 SYLVAN AVE. SUITE 326
ENGLEWOOD CLIFFS NJ
07632-2733
US

V. Phone/Fax

Practice location:
  • Phone: 908-246-9586
  • Fax: 201-408-4347
Mailing address:
  • Phone: 908-246-9586
  • Fax: 201-408-4347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA03284400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4960807
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: