MEDICARE: DR. HYUNGRIM OH D.D.S.

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	50501	CA

General Provider Information

NPI Number	:	1588712665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HYUNGRIM OH D.D.S.

Provider Business Mailing Address
First Line	:	14709 RINALDI ST
Second Line	:
City	:	SAN FERNANDO
State	:	CA
Zip	:	91340-4138
Country	:	US
Telephone Number	:	661-477-8124
Fax Number	:	818-361-8487

Provider Business Practice Location Address
First Line	:	14709 RINALDI ST
Second Line	:
City	:	SAN FERNANDO
State	:	CA
Zip	:	91340-4138
Country	:	US
Telephone Number	:	818-361-1231
Fax Number	:	818-361-8487

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	08/22/2013

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