Provider Demographics
NPI:1336445550
Name:PENN SOH, DDS, CORP
Entity Type:Organization
Organization Name:PENN SOH, DDS, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PENN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-505-0106
Mailing Address - Street 1:5300 LANKERSHIM BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-3163
Mailing Address - Country:US
Mailing Address - Phone:818-505-0106
Mailing Address - Fax:818-505-1063
Practice Address - Street 1:5300 LANKERSHIM BLVD STE 105
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-3163
Practice Address - Country:US
Practice Address - Phone:818-505-0106
Practice Address - Fax:818-505-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57033261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental