Provider Demographics
NPI:1053633123
Name:YOUNG HO SOHN MD PLLC
Entity Type:Organization
Organization Name:YOUNG HO SOHN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:HO
Authorized Official - Last Name:SOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-832-1440
Mailing Address - Street 1:4160 JOHN R ST
Mailing Address - Street 2:SUITE 515
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2020
Mailing Address - Country:US
Mailing Address - Phone:313-832-1440
Mailing Address - Fax:313-832-0712
Practice Address - Street 1:4160 JOHN R ST
Practice Address - Street 2:SUITE 515
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2020
Practice Address - Country:US
Practice Address - Phone:313-832-1440
Practice Address - Fax:313-832-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIYS034239174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0608209801OtherBLUE CROSS BLUE SHIELD
MI3381920Medicaid
MIE40180Medicare UPIN
MI3381920Medicaid