1881707172 NPI number — DR. HEUNG KIL OH MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881707172 NPI number — DR. HEUNG KIL OH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OH
Provider First Name:
HEUNG
Provider Middle Name:
KIL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OH
Provider Other First Name:
HENRY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1881707172
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22101 MOROSS RD
Provider Second Line Business Mailing Address:
PB2 SUITE 480
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-343-3048
Provider Business Mailing Address Fax Number:
313-343-7349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22101 MOROSS RD
Provider Second Line Business Practice Location Address:
PB2 SUITE 480 SJHMC DEPARTMENT OF TRANSPLANT SURGERY
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-343-3048
Provider Business Practice Location Address Fax Number:
313-343-7349
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  4301034672 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2625932 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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