Provider Demographics
NPI:1497283949
Name:SOHN, SUNG (LAC)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:
Last Name:SOHN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3643 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2024
Mailing Address - Country:US
Mailing Address - Phone:909-446-6864
Mailing Address - Fax:
Practice Address - Street 1:3643 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-2024
Practice Address - Country:US
Practice Address - Phone:909-446-6864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17690171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist