Provider Demographics
NPI:1730403403
Name:DONG WHA OHM MD PC
Entity type:Organization
Organization Name:DONG WHA OHM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-875-9001
Mailing Address - Street 1:PO BOX 4040
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-0040
Mailing Address - Country:US
Mailing Address - Phone:810-875-9001
Mailing Address - Fax:810-875-9001
Practice Address - Street 1:1085 S LINDEN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3421
Practice Address - Country:US
Practice Address - Phone:810-262-2008
Practice Address - Fax:810-230-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010348892086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3207650Medicaid