Provider Demographics
NPI:1437110327
Name:CHARLES K. OH, MD INC.
Entity type:Organization
Organization Name:CHARLES K. OH, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:KYUMIN
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-508-1600
Mailing Address - Street 1:2552 WALNUT AVENUE
Mailing Address - Street 2:130
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:714-508-1600
Mailing Address - Fax:714-665-8304
Practice Address - Street 1:2552 WALNUT AVENUE
Practice Address - Street 2:130
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-508-1600
Practice Address - Fax:714-665-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83003207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18895Medicare PIN
CAH58685Medicare UPIN