Provider Demographics
NPI:1992161848
Name:OH, YOUNG KYU
Entity type:Individual
Prefix:
First Name:YOUNG KYU
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10812 72ND AVE STE 100B
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7079
Mailing Address - Country:US
Mailing Address - Phone:718-687-2474
Mailing Address - Fax:718-880-2662
Practice Address - Street 1:10812 72ND AVE STE 100B
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-687-2474
Practice Address - Fax:718-880-2662
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005207171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist