Provider Demographics
NPI:1134383284
Name:SOPHIA S. HOM, MD, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:SOPHIA S. HOM, MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:SUNG
Authorized Official - Last Name:HOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-482-1725
Mailing Address - Street 1:616 ST PAUL AVE
Mailing Address - Street 2:SUITE 732
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-2022
Mailing Address - Country:US
Mailing Address - Phone:213-482-1725
Mailing Address - Fax:
Practice Address - Street 1:1245 WILSHIRE BOULVARD
Practice Address - Street 2:SUITE 804
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4810
Practice Address - Country:US
Practice Address - Phone:213-482-1725
Practice Address - Fax:213-482-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70336208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G703360Medicaid
CAG70336Medicare PIN