Provider Demographics
NPI:1215978051
Name:OH, JONATHAN CHUN (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CHUN
Last Name:OH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:3410 WORTH ST
Practice Address - Street 2:DEPT OF GYNECOLOGIC ONCOLOGY
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2003
Practice Address - Country:US
Practice Address - Phone:214-370-1301
Practice Address - Fax:214-370-1318
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5368207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R1517OtherBLUE CROSS OF TEXAS
TX166212404Medicaid
TX166214401Medicaid
TX166214402Medicaid
OK200191530AMedicaid
TX166212403Medicaid
TX166212405Medicaid
TX166212405Medicaid
TX166212404Medicaid
OK200191530AMedicaid
TX8C9345Medicare PIN
TX166214402Medicaid
TX8C1906Medicare PIN
I09150Medicare UPIN