Healthcare Provider Details

I. General information

NPI: 1720665292
Provider Name (Legal Business Name): SOPHIE MOU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S SAN MATEO DR
SAN MATEO CA
94401-3805
US

IV. Provider business mailing address

858 W MC KINLEY AVE
SUNNYVALE CA
94086-5918
US

V. Phone/Fax

Practice location:
  • Phone: 650-652-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA196445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: