Provider Demographics
NPI:1073595682
Name:SOHN, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:SOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 CHERRY AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-2057
Mailing Address - Country:US
Mailing Address - Phone:562-435-5753
Mailing Address - Fax:562-216-9053
Practice Address - Street 1:6400 CANOGA AVE STE 163
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2435
Practice Address - Country:US
Practice Address - Phone:818-702-0100
Practice Address - Fax:818-702-1741
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235605207R00000X
TNMD40703207R00000X
CAC55035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3720181Medicaid
VA010270090Medicaid
TN3337556Medicaid
TN3337556Medicaid
TN3720181Medicaid
TN103I086169Medicare UPIN
TNCA5023Medicare PIN
TN3700592Medicare PIN
VA010270090Medicaid
0281780003Medicare PIN
0281780001Medicare PIN