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General NPI Number Information
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NPI Number | 1265603773
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Entity Type | Organization
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Legal Business Name | JACK B. OH, DDS A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 2705 S DIAMOND BAR BLVD STE 288
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City | DIAMOND BAR
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State | CA
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Zip | 91765-3555
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Country | US
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Telephone | 909-444-9400
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Fax | 909-444-3311
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Provider Business Mailing Address
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Address Line | 2705 S DIAMOND BAR BLVD STE 288
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City | DIAMOND BAR
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State | CA
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Zip | 91765-3555
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Country | US
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Telephone | 909-444-9400
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Fax | 909-444-3311
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK B OH
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Credential | DDS
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Telephone | 909-444-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 42205
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License Number State | CA
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