Healthcare Provider Details

I. General information

NPI: 1518028638
Provider Name (Legal Business Name): SUNG H SOHN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 NEILSON ST
WATSONVILLE CA
95076-2468
US

IV. Provider business mailing address

PO BOX 1870
WATSONVILLE CA
95077-1870
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-0222
  • Fax: 831-707-2777
Mailing address:
  • Phone: 831-728-8250
  • Fax: 831-707-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number45620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: