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General NPI Number Information
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NPI Number | 1306968326
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Entity Type | Individual
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Provider Name | SUSAN JIYOUNG OH DDS
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Gender | Female
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 1227 N ILLINOIS 83 #E 1227 N STATE 83
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City | GRAYSLAKE
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State | IL
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Zip | 60030
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Country | US
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Telephone | 847-548-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 819 PARK AVE
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City | LAKE VILLA
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State | IL
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Zip | 60046-5030
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Country | US
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Telephone | 847-245-4709
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019-025715
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License Number State | IL
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