Healthcare Provider Details

I. General information

NPI: 1528187507
Provider Name (Legal Business Name): YOUNGSOO OH P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 254TH ST
LITTLE NECK NY
11362-2412
US

IV. Provider business mailing address

6330 254TH ST
LITTLE NECK NY
11362-2412
US

V. Phone/Fax

Practice location:
  • Phone: 718-428-2383
  • Fax:
Mailing address:
  • Phone: 718-428-2383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003477
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16067
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: