Provider Demographics
NPI:1306976618
Name:OH, SAEKYU (DMD)
Entity type:Individual
Prefix:
First Name:SAEKYU
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:PO BOX 10059
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-0059
Mailing Address - Country:US
Mailing Address - Phone:661-600-2468
Mailing Address - Fax:
Practice Address - Street 1:2631 FASHION PL STE A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-3068
Practice Address - Country:US
Practice Address - Phone:661-871-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD44049OtherDENTI-CAL PROVIDER NUMBER