MEDICARE: HAERYONG OH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	A100397	CA

General Provider Information

NPI Number	:	1225206881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAERYONG OH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	4910 AIRPORT PLAZA DR STE 100
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1377
Country	:	US
Telephone Number	:	562-429-2473
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2008
Last Update Date	:	01/04/2026

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Directions to “ HAERYONG OH M.D.” Practice Location

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