Healthcare Provider Details

I. General information

NPI: 1093745549
Provider Name (Legal Business Name): SUNG KYU HENRY OH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 S BROAD ST
PHILADELPHIA PA
19145-2303
US

IV. Provider business mailing address

717 HOLLOW RD
RADNOR PA
19087-2803
US

V. Phone/Fax

Practice location:
  • Phone: 215-468-7722
  • Fax: 215-468-7729
Mailing address:
  • Phone: 610-688-9012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD-032826L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: