Provider Demographics
NPI:1134894918
Name:SOWHO, SUNNY
Entity type:Individual
Prefix:
First Name:SUNNY
Middle Name:
Last Name:SOWHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 MACARTHUR BLVD # 4
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:353 MACARTHUR BLVD # 4
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-3233
Practice Address - Country:US
Practice Address - Phone:510-424-5382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC3416956Medicaid