Provider Demographics
NPI:1194101527
Name:OH, JIN SUB (DMD)
Entity type:Individual
Prefix:DR
First Name:JIN SUB
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 E MAIN ST
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3028
Mailing Address - Country:US
Mailing Address - Phone:914-242-3906
Mailing Address - Fax:
Practice Address - Street 1:359 E MAIN ST
Practice Address - Street 2:SUITE #2E
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3028
Practice Address - Country:US
Practice Address - Phone:914-242-3906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058130122300000X, 1223P0700X
NJ22DI02550500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist