Healthcare Provider Details

I. General information

NPI: 1154963981
Provider Name (Legal Business Name): SO YONG HA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N BROADWAY
YONKERS NY
10701-1330
US

IV. Provider business mailing address

30 LONGVIEW DR
MAHOPAC NY
10541-4853
US

V. Phone/Fax

Practice location:
  • Phone: 914-309-8356
  • Fax:
Mailing address:
  • Phone: 914-309-8356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number6282
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: