Healthcare Provider Details

I. General information

NPI: 1184762577
Provider Name (Legal Business Name): JEONG-HYEON SOHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 FLOYD CURL DR FL 6
SAN ANTONIO TX
78229-3931
US

IV. Provider business mailing address

8300 FLOYD CURL DR FL 6
SAN ANTONIO TX
78229-3931
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-9400
  • Fax: 210-450-6024
Mailing address:
  • Phone: 210-450-9400
  • Fax: 210-450-6024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberR0822
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0066175
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberQ4846
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number38424
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberQ4846
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: