Healthcare Provider Details

I. General information

NPI: 1205776978
Provider Name (Legal Business Name): SOMOS IPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 EXTERIOR ST FL 1
BRONX NY
10463-7104
US

IV. Provider business mailing address

2910 EXTERIOR ST FL 1
BRONX NY
10463-7104
US

V. Phone/Fax

Practice location:
  • Phone: 833-766-6769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: YIQIN JIANG
Title or Position: SVP
Credential:
Phone: 774-275-1855