NPIMap

Organization Active NPI

Charles K. Oh, MD Inc.

  • Otolaryngology Physician
  • Tustin, CA
National Provider Identifier
1437110327
Registry record updated Nov 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
A83003 Issued in CA
Legal business name
CHARLES K. OH, MD INC.
Practice address
2552 Walnut Avenue
130
Tustin, CA 92780
Phone
(714) 508-1600
Fax
(714) 665-8304
NPI assigned
Mar 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Charles Kyumin Oh, MDNPI 1780689042
Title
Provider
Phone
(714) 508-1600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X A83003 CA Primary

Addresses

Primary practice location

2552 Walnut Avenue
130
Tustin, CA 92780

Mailing address

2552 Walnut Avenue
130
Tustin, CA 92780
Phone (714) 508-1600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050617000957 CA Part B Supplier - Clinic/Group Practice 4486698677 Receives reassigned benefits from 2 practitioners
Practice locations: Los Alamitos, CA; Tustin, CA

National Provider Directory

National Provider Directory

Locations

12665 Garden Grove Blvd
Ste 711
Garden Grove, CA 92843
Phone (714) 534-1965

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352160000000",
    "number": "1437110327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2552 WALNUT AVENUE",
            "address_2": "130",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "92780",
            "telephone_number": "714-508-1600",
            "fax_number": "714-665-8304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2552 WALNUT AVENUE",
            "address_2": "130",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "92780",
            "telephone_number": "714-508-1600",
            "fax_number": "714-665-8304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES K. OH, MD INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-30",
        "last_updated": "2012-11-06",
        "status": "A",
        "authorized_official_last_name": "OH",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "KYUMIN",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "714-508-1600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A83003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.