MEDICARE: DR. JOOYOUNG OH

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	122300000X	Dentist	55575	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558559401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOOYOUNG OH

Provider Business Mailing Address
First Line	:	2107 LAKE PARK DR SE
Second Line	:	APT. T
City	:	SMYRNA
State	:	GA
Zip	:	30080-7603
Country	:	US
Telephone Number	:	800-417-4444
Fax Number	:	714-571-3560

Provider Business Practice Location Address
First Line	:	678 N WILSON WAY
Second Line	:	#D
City	:	STOCKTON
State	:	CA
Zip	:	95205-4272
Country	:	US
Telephone Number	:	209-937-9000
Fax Number	:	209-939-1649

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

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	10/04/2007

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