Provider Demographics
NPI:1770146573
Name:OH, KYU YOUNG (MD)
Entity type:Individual
Prefix:
First Name:KYU YOUNG
Middle Name:
Last Name:OH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KYU Y
Other - Middle Name:
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:255 W 88TH ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1717
Mailing Address - Country:US
Mailing Address - Phone:646-912-8774
Mailing Address - Fax:
Practice Address - Street 1:255 W 88TH ST APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1717
Practice Address - Country:US
Practice Address - Phone:646-912-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA114075002084P0800X
NY3061812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1588610604OtherHMH NPI