Healthcare Provider Details

I. General information

NPI: 1740200914
Provider Name (Legal Business Name): SONY ALAN TA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 S MAIN ST
LOS ANGELES CA
90003-1215
US

IV. Provider business mailing address

242 E 6TH ST
LOS ANGELES CA
90014-2117
US

V. Phone/Fax

Practice location:
  • Phone: 323-846-4104
  • Fax: 323-234-6518
Mailing address:
  • Phone: 213-833-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA90931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: