Healthcare Provider Details

I. General information

NPI: 1952660474
Provider Name (Legal Business Name): PAUL JUNGWAN SOHN DDS, MMSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 LINCOLN AVE
HAWTHORNE NJ
07506-1260
US

IV. Provider business mailing address

23 BIRCH ST
RIDGEFIELD PARK NJ
07660-2312
US

V. Phone/Fax

Practice location:
  • Phone: 201-345-3892
  • Fax: 201-345-3893
Mailing address:
  • Phone: 917-715-6299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02658300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number058636
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1856391
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number22DI02658300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: