Basic Information
| Provider Information | |||||||||
| NPI: | 1053394676 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOM | ||||||||
| FirstName: | SOPHIA | ||||||||
| MiddleName: | SUNG | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4401 PENN AVENUE | ||||||||
| Address2: | 5TH FL. FACULTY PAVILION | ||||||||
| City: | PGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126927626 | ||||||||
| FaxNumber: | 4126925817 | ||||||||
| Practice Location | |||||||||
| Address1: | 4401 PENN AVENUE | ||||||||
| Address2: | 5TH FL. FACULTY PAVILION | ||||||||
| City: | PGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126927626 | ||||||||
| FaxNumber: | 4126925817 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2005 | ||||||||
| LastUpdateDate: | 08/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | G70336 | CA | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | MD050543L | PA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 00G703360 | 05 | CA | MEDICAID | G70336 | 01 | CA | CALIFORNIA STATE LICENSE | OTHER |