Provider Demographics
NPI:1013069871
Name:OH, MICHAEL MYUNGSUP (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MYUNGSUP
Last Name:OH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MYUNGSUP
Other - Middle Name:
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:111 E CARSON ST
Mailing Address - Street 2:STE 10
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745
Mailing Address - Country:US
Mailing Address - Phone:310-835-7610
Mailing Address - Fax:310-835-7879
Practice Address - Street 1:111 E CARSON ST
Practice Address - Street 2:STE 10
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745
Practice Address - Country:US
Practice Address - Phone:310-835-7610
Practice Address - Fax:310-835-7879
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice