Basic Information
| Provider Information | |||||||||
| NPI: | 1689633794 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OH | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | YOUNGBOK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2544 COURT DR STE G | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280543450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048549990 | ||||||||
| FaxNumber: | 7048549045 | ||||||||
| Practice Location | |||||||||
| Address1: | 2544 COURT DR STE G | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280543450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048549990 | ||||||||
| FaxNumber: | 7048549045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 01054173A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 2010-00244 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 10825690 | 01 | IN | CAQH NUMBER | OTHER | 000000202136 | 01 | IN | ANTHEM PROVIDER NUMBER | OTHER | 1689633794 | 05 | NC | MEDICAID | 200340710 | 05 | IN | MEDICAID | 510421 | 01 | IN | PHCS PID NUMBER | OTHER | 159C4 | 01 | NC | BCBS | OTHER |