Healthcare Provider Details

I. General information

NPI: 1114984101
Provider Name (Legal Business Name): MR. CHU HYON SOH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 MDOS/SGOSY UNIT 5227
APO AP
96328
JP

IV. Provider business mailing address

PSC 78 BOX 1506
APO AP
96326
JP

V. Phone/Fax

Practice location:
  • Phone: 011813117557577
  • Fax:
Mailing address:
  • Phone: 011813117572395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number4798
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: