Individual provider Active NPI

Sang-Rog Oh, M.D.

  • Ophthalmology Physician
  • La Jolla, CA
National Provider Identifier
1659588978
Registry record updated Dec 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
A106750 Issued in CA
Practice address
9415 Campus Point Dr
MC 0946
La Jolla, CA 92093-1350
Phone
(858) 905-3466
NPI assigned
May 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 236932 NY
Ophthalmology Physician 207W00000X A106750 CA Primary

Addresses

Primary practice location

9415 Campus Point Dr
MC 0946
La Jolla, CA 92093-1350

Mailing address

2 Mott St
Suite 206
New York, NY 10013-5003

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090528000136 CA Practitioner - Ophthalmology 8729174248 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

7373 W Lane
Stockton, CA 95210-3377
Phone (209) 476-2000

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
106750CAMDGeneral Practice Dentistry
A106750CAMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California Ophthalmology CurrentSince May 1, 2009 Accepting new patients
Regents of the University of California CurrentSince May 1, 2009 Accepting new patients
Permanente Medical Group Inc Ophthalmology Current Accepting new patients
Permanente Medical Group, Inc CurrentSince Dec 18, 2011 Accepting new patients
Permanente Medical Group Inc Ophthalmology CurrentSince Dec 18, 2011 Accepting new patients
Advanced Eye Physician PLLC Ophthalmology PastSince Jan 1, 2005 Accepting new patients
Grand Fashion Optical, Inc Ophthalmology PastSince Nov 17, 2019 Accepting new patients

Locations

9415 Campus Point Dr
#946
La Jolla, CA 92093
Phone (858) 534-6290

File 57326
Los Angeles, CA 90074

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

2025 Morse Ave
Sacramento, CA 95825

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1659588978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 MOTT ST",
            "address_2": "SUITE 206",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100135003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9415 CAMPUS POINT DR",
            "address_2": "MC 0946",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920931350",
            "telephone_number": "858-905-3466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OH",
        "first_name": "SANG-ROG",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "236932",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "A106750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2025 Morse Ave",
            "city": "Sacramento",
            "state": "CA",
            "country_code": "US",
            "postal_code": "958252115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

Verify at the official NPI Registry.