Provider Demographics
NPI:1588712665
Name:OH, HYUNGRIM (DDS)
Entity type:Individual
Prefix:DR
First Name:HYUNGRIM
Middle Name:
Last Name:OH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14709 RINALDI ST
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-4138
Mailing Address - Country:US
Mailing Address - Phone:661-477-8124
Mailing Address - Fax:818-361-8487
Practice Address - Street 1:14709 RINALDI ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4138
Practice Address - Country:US
Practice Address - Phone:818-361-1231
Practice Address - Fax:818-361-8487
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist