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General NPI Number Information
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NPI Number | 1154322428
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Entity Type | Organization
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Legal Business Name | MANSFIELD RADIATION ONCOLOGY
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 335 GLESSNER AVE
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City | MANSFIELD
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State | OH
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Zip | 44903-2269
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Country | US
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Telephone | 419-526-8622
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Fax | 419-526-8198
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Provider Business Mailing Address
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Address Line | PO BOX 567
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City | CHAGRIN FALLS
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State | OH
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Zip | 44022-0567
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Country | US
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Telephone | 216-896-5683
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Fax | 216-464-5176
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KYEE KOH
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Credential | M.D.
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Telephone | 419-526-8622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State | OH
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