Provider Demographics
NPI:1548503733
Name:OH, MI KYEONG (NP)
Entity type:Individual
Prefix:
First Name:MI KYEONG
Middle Name:
Last Name:OH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 MADISON AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6514
Mailing Address - Country:US
Mailing Address - Phone:212-241-5315
Mailing Address - Fax:212-987-9310
Practice Address - Street 1:1425 MADISON AVE FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6514
Practice Address - Country:US
Practice Address - Phone:212-241-5315
Practice Address - Fax:212-987-9310
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily