Provider Demographics
NPI:1306847439
Name:SOHN, SUNG J (MD)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:J
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:PO BOX 605
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-0605
Mailing Address - Country:US
Mailing Address - Phone:845-294-7833
Mailing Address - Fax:845-294-5820
Practice Address - Street 1:1997 ROUTE 17M
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-5229
Practice Address - Country:US
Practice Address - Phone:845-294-7833
Practice Address - Fax:845-294-5820
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129468207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00545648Medicaid
C06971Medicare UPIN
NY00545648Medicaid