=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295025427
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WON SOHN, M.D.,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2011
-----------------------------------------------------
Last Update Date | 04/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 213-33 39TH AVE SUITE 248
-----------------------------------------------------
City | BAYSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-428-5333
-----------------------------------------------------
Fax | 718-428-5332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O.BOX 605043
-----------------------------------------------------
City | BAYSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-428-5333
-----------------------------------------------------
Fax | 718-428-5332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. WON SOHN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 718-781-5821
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 207025
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------