Provider Demographics
NPI:1447470968
Name:ANTHONY S. OH, M.D, A MEDICAL CORPORATON
Entity type:Organization
Organization Name:ANTHONY S. OH, M.D, A MEDICAL CORPORATON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:S
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-621-7647
Mailing Address - Street 1:4950 SAN BERNARDINO ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2328
Mailing Address - Country:US
Mailing Address - Phone:909-621-7647
Mailing Address - Fax:877-887-5774
Practice Address - Street 1:4950 SAN BERNARDINO ST STE 202
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2328
Practice Address - Country:US
Practice Address - Phone:909-621-7647
Practice Address - Fax:877-887-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA850292208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A850290Medicaid
CA00A850292Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION #
CA00A850290Medicaid