Provider Demographics
NPI:1063694867
Name:HOCKING VALLEY OB/GYN
Entity type:Organization
Organization Name:HOCKING VALLEY OB/GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YONG
Authorized Official - Middle Name:W
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-687-0087
Mailing Address - Street 1:PO BOX 950
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-0950
Mailing Address - Country:US
Mailing Address - Phone:740-654-4427
Mailing Address - Fax:
Practice Address - Street 1:1147 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4056
Practice Address - Country:US
Practice Address - Phone:740-687-0087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064371207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0897383Medicaid
OHHO9275222Medicare PIN
OH0897383Medicaid