Provider Demographics
NPI:1699004234
Name:SOH, DOSOON (MNP)
Entity Type:Individual
Prefix:
First Name:DOSOON
Middle Name:
Last Name:SOH
Suffix:
Gender:F
Credentials:MNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22618 HIGHWAY 99 STE 106
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8395
Mailing Address - Country:US
Mailing Address - Phone:425-409-9247
Mailing Address - Fax:206-535-2442
Practice Address - Street 1:22618 HIGHWAY 99 STE 106
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8395
Practice Address - Country:US
Practice Address - Phone:425-409-9247
Practice Address - Fax:206-535-2442
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00094879163W00000X
WAAP60126966363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1699004234Medicaid