Provider Demographics
NPI:1780703124
Name:OH, KEVIN SHAWN (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SHAWN
Last Name:OH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 BLOSSOM STREET
Mailing Address - Street 2:COX 3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-724-1159
Mailing Address - Fax:617-726-3603
Practice Address - Street 1:100 BLOSSOM STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-1159
Practice Address - Fax:617-726-3603
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2012-03-23
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Provider Licenses
StateLicense IDTaxonomies
MI43010836702085R0001X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program