MEDICARE: DR. JESSICA 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1578917308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA OH M.D.

Provider Business Mailing Address
First Line	:	4729 FRANKLIN BLVD
Second Line	:	APT 3
City	:	CLEVELAND
State	:	OH
Zip	:	44102-3462
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4729 FRANKLIN BLVD
Second Line	:	APT 3
City	:	CLEVELAND
State	:	OH
Zip	:	44102-3462
Country	:	US
Telephone Number	:	630-399-6513
Fax Number	:

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

Provider Enumeration Date	:	04/18/2016
Last Update Date	:	01/17/2017

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