MEDICARE: JOHANNA HYUNKYUNG SOHN DDS

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	1223G0001X	General Practice Dentistry	0401-412341	VA

General Provider Information

NPI Number	:	1326284951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHANNA HYUNKYUNG SOHN DDS

Provider Business Mailing Address
First Line	:	7670 PARKER ROAD
Second Line	:
City	:	FORT RILEY
State	:	KS
Zip	:	66442-4247
Country	:	US
Telephone Number	:	785-239-4261
Fax Number	:

Provider Business Practice Location Address
First Line	:	7670 PARKER ST
Second Line	:
City	:	FORT RILEY
State	:	KS
Zip	:	66442-4247
Country	:	US
Telephone Number	:	785-239-4261
Fax Number	:

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

Provider Enumeration Date	:	01/03/2009
Last Update Date	:	10/12/2022

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