Provider Demographics
NPI:1366555070
Name:OH, JEANA SO RYONG (MD)
Entity type:Individual
Prefix:DR
First Name:JEANA
Middle Name:SO RYONG
Last Name:OH
Suffix:
Gender:F
Credentials:MD
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 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1900
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-383-3553
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000490072085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7087158OtherDSHS-UAOM
WA0235927OtherLABOR AND INDUSTRIES-UNION AVENUE OPEN MRI
WA8947304OtherLABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI
WA8947305OtherLABOR AND INDUSTRIES CRIME VICTIMS-TRA
WA0243529OtherLABOR AND INDUSTRIES-CAROL MILGARD BREAST CENTER
WA1089454Medicaid
WA8949629OtherLABOR AND INDUSTRIES CRIME VICTIMS-CAROL MILGARD BREAST CENTER
WA0235916OtherLABOR AND INDUSTRIES-TRA
WA8951847OtherLABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST
WA0249540OtherLABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
WA7087158OtherDSHS-UAOM
WAG8878590OtherPTAN-CMBC
WAG8882930OtherPTAN-MIO1
WA8947304OtherLABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI
WA0235916OtherLABOR AND INDUSTRIES-TRA
NJI23462Medicare UPIN
NJ086433Medicare ID - Type Unspecified