Provider Demographics
NPI:1306127238
Name:OH, SOOJIN (D,D,S)
Entity type:Individual
Prefix:
First Name:SOOJIN
Middle Name:
Last Name:OH
Suffix:
Gender:F
Credentials:D,D,S
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:D,D,S
Mailing Address - Street 1:11262 EXETER ST
Mailing Address - Street 2:APT. D
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3049
Mailing Address - Country:US
Mailing Address - Phone:951-907-3500
Mailing Address - Fax:
Practice Address - Street 1:11262 EXETER ST
Practice Address - Street 2:APT. D
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3049
Practice Address - Country:US
Practice Address - Phone:951-907-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60651122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA60651OtherDENTAL BOARD OF CALIFORNIA