Healthcare Provider Details

I. General information

NPI: 1386375178
Provider Name (Legal Business Name): DANIEL HYEONGJIN SOH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W KINGSBRIDGE RD
BRONX NY
10468-3904
US

IV. Provider business mailing address

170 W 225TH ST APT 601
BRONX NY
10463-5039
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-9000
  • Fax:
Mailing address:
  • Phone: 319-855-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2022026228
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: