Provider Demographics
NPI:1114476975
Name:SOHN, SOOYEOL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOOYEOL
Middle Name:
Last Name:SOHN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:
Other - Last Name:SOHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:230 W BADILLO ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1906
Mailing Address - Country:US
Mailing Address - Phone:626-332-2775
Mailing Address - Fax:
Practice Address - Street 1:230 W BADILLO ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1906
Practice Address - Country:US
Practice Address - Phone:626-332-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100896122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist