Healthcare Provider Details

I. General information

NPI: 1710108345
Provider Name (Legal Business Name): JUNG DUK OH MD,PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 RIVERSIDE DR
BINGHAMTON NY
13905-4176
US

IV. Provider business mailing address

201 EVERGREEN ST APT 5-3D
VESTAL NY
13850-2786
US

V. Phone/Fax

Practice location:
  • Phone: 607-770-1155
  • Fax: 607-203-0821
Mailing address:
  • Phone: 703-922-1313
  • Fax: 703-922-1111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101256562
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD042535
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0076005
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number295951
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: