Healthcare Provider Details

I. General information

NPI: 1992498711
Provider Name (Legal Business Name): SOHEE CHUNG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S ANAHEIM BLVD STE 101
ANAHEIM CA
92805-3848
US

IV. Provider business mailing address

100 S ANAHEIM BLVD STE 101
ANAHEIM CA
92805-3848
US

V. Phone/Fax

Practice location:
  • Phone: 877-696-3622
  • Fax:
Mailing address:
  • Phone: 877-696-3622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A24299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: