Basic Information
| Provider Information | |||||||||
| NPI: | 1437110327 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLES K. OH, MD INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2552 WALNUT AVENUE | ||||||||
| Address2: | 130 | ||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145081600 | ||||||||
| FaxNumber: | 7146658304 | ||||||||
| Practice Location | |||||||||
| Address1: | 2552 WALNUT AVENUE | ||||||||
| Address2: | 130 | ||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145081600 | ||||||||
| FaxNumber: | 7146658304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 11/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | OH | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | KYUMIN | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 7145081600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | A83003 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.