Provider Demographics
NPI:1174784896
Name:OH, IRVIN CHUNG (MD)
Entity type:Individual
Prefix:
First Name:IRVIN
Middle Name:CHUNG
Last Name:OH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:47 COLLEGE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3209
Mailing Address - Country:US
Mailing Address - Phone:203-785-7248
Mailing Address - Fax:203-785-7132
Practice Address - Street 1:800 HOWARD AVE FL 1
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1369
Practice Address - Country:US
Practice Address - Phone:203-785-2579
Practice Address - Fax:203-785-7232
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2021-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY254107207X00000X, 207XX0004X
CT67489207XX0004X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery