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General NPI Number Information
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NPI Number | 1023692100
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Entity Type | Individual
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Provider Name | CONNIE OH MD
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Gender | Female
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Dates
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Enumeration Date | 05/05/2021
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 22 CORPORATE PLAZA DR
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7985
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Country | US
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Telephone | 949-722-7038
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Fax |
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Provider Business Mailing Address
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Address Line | 22 CORPORATE PLAZA DR
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7985
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | A181638
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License Number State | CA
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