MEDICARE: HAEYOUNG SOHN

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	1041C0700X	Clinical Social Worker	LCS16869	CA

General Provider Information

NPI Number	:	1942883004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAEYOUNG SOHN

Provider Business Mailing Address
First Line	:	2624 DURANGO LN
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-2109
Country	:	US
Telephone Number	:	510-384-2901
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 49TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-2237
Country	:	US
Telephone Number	:	510-613-0330
Fax Number	:	510-569-4589

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

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	05/05/2021

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