Healthcare Provider Details

I. General information

NPI: 1285784017
Provider Name (Legal Business Name): ALICE YOOSUN HO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BLOSSOM STREET COX BUILDING 3
BOSTON MA
02114
US

IV. Provider business mailing address

100 BLOSSOM STREET COX BUILDING 3
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-7250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number231369
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number273762
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: