MEDICARE: DR. JEREMY SOH PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	NONE
2	102L00000X	Psychoanalyst	RPS277	CA
3	102L00000X	Psychoanalyst	RP277	CA

General Provider Information

NPI Number	:	1104976976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY SOH PH.D.

Provider Business Mailing Address
First Line	:	255 S 17TH ST STE 1508
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6215
Country	:	US
Telephone Number	:	510-822-6898
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 S 17TH ST STE 1508
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6215
Country	:	US
Telephone Number	:	510-822-6898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	12/23/2024

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Directions to “ DR. JEREMY SOH PH.D.” Practice Location

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