Healthcare Provider Details

I. General information

NPI: 1639300361
Provider Name (Legal Business Name): JULIE EUNJU OH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE EUNJU KIM M.D

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FIRST AVENUE AT 16TH STREET
NEW YORK NY
10003
US

IV. Provider business mailing address

FIRST AVENUE AT 16TH STREET
NEW YORK NY
10003
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-2946
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number272412
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: