Provider Demographics
NPI:1790195485
Name:TOTAL ENT CARE LLC
Entity Type:Organization
Organization Name:TOTAL ENT CARE LLC
Other - Org Name:TOTAL ENT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-889-0795
Mailing Address - Street 1:2329 WILLOW VALE DR
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-1504
Mailing Address - Country:US
Mailing Address - Phone:443-418-0244
Mailing Address - Fax:
Practice Address - Street 1:733 W 40TH STREET
Practice Address - Street 2:SUITE 20
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2107
Practice Address - Country:US
Practice Address - Phone:410-889-0795
Practice Address - Fax:877-766-8925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD57335207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402587300Medicaid