Healthcare Provider Details

I. General information

NPI: 1720442361
Provider Name (Legal Business Name): HENDRICK SOH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2016
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 MARKET ST STE 1608
SAN FRANCISCO CA
94104-5317
US

IV. Provider business mailing address

1100 GLENDON AVE PH 4
LOS ANGELES CA
90024-3526
US

V. Phone/Fax

Practice location:
  • Phone: 833-931-1716
  • Fax: 575-205-1436
Mailing address:
  • Phone:
  • Fax: 575-205-1436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA151214
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA151214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: