Basic Information
| Provider Information | |||||||||
| NPI: | 1295025427 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WON SOHN, M.D.,P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O.BOX 605043 | ||||||||
| Address2: | |||||||||
| City: | BAYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184285333 | ||||||||
| FaxNumber: | 7184285332 | ||||||||
| Practice Location | |||||||||
| Address1: | 213-33 39TH AVE | ||||||||
| Address2: | SUITE 248 | ||||||||
| City: | BAYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184285333 | ||||||||
| FaxNumber: | 7184285332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2011 | ||||||||
| LastUpdateDate: | 04/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | SOHN | ||||||||
| AuthorizedOfficialFirstName: | WON | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7187815821 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | 207025 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
ID Information
| ID | Type | State | Issuer | Description | 02088860 | 05 | NY | MEDICAID |