Provider Demographics
NPI:1982970513
Name:OH, EUGENE (MD, PHD, SCM)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:MD, PHD, SCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34503 9TH AVE S STE 320
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8726
Mailing Address - Country:US
Mailing Address - Phone:253-759-4522
Mailing Address - Fax:360-373-0102
Practice Address - Street 1:34503 9TH AVE S STE 320
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8726
Practice Address - Country:US
Practice Address - Phone:253-759-4522
Practice Address - Fax:360-373-0102
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML602860242086S0122X
WAMD60470774208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2110553Medicaid