Healthcare Provider Details

I. General information

NPI: 1821592114
Provider Name (Legal Business Name): SOPHIA EUN HWANGBO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EUN HWANGBO MD

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 30TH AVE
ASTORIA NY
11102-2448
US

IV. Provider business mailing address

PO BOX 28082
NEW YORK NY
10087-8082
US

V. Phone/Fax

Practice location:
  • Phone: 212-987-3100
  • Fax:
Mailing address:
  • Phone: 212-987-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number315463
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number315463
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: