Basic Information
| Provider Information | |||||||||
| NPI: | 1275851834 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SON | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 N INDEPENDENCE MALL W | ||||||||
| Address2: | SUITE 701A | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191061554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2678001009 | ||||||||
| FaxNumber: | 2678001869 | ||||||||
| Practice Location | |||||||||
| Address1: | 190 N INDEPENDENCE MALL W | ||||||||
| Address2: | SUITE 701A | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191061554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2678001009 | ||||||||
| FaxNumber: | 2678001869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2010 | ||||||||
| LastUpdateDate: | 04/17/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 271154 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 25MA09966400 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD459338 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.