Provider Demographics
NPI:1477972123
Name:SOHN, JENNIFER K (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:SOHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 MOE RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3822
Mailing Address - Country:US
Mailing Address - Phone:518-383-2425
Mailing Address - Fax:
Practice Address - Street 1:532 MOE RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3822
Practice Address - Country:US
Practice Address - Phone:518-383-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293333208000000X
PAMD461563208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics