Provider Demographics
NPI:1790245256
Name:HO, SOPHIA PHUONG (DO)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:PHUONG
Last Name:HO
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:PHUONG
Other - Middle Name:BAO
Other - Last Name:HO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21634 RETREAT PKWY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-6100
Mailing Address - Country:US
Mailing Address - Phone:951-493-6925
Mailing Address - Fax:951-826-8135
Practice Address - Street 1:21634 RETREAT PKWY
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-6100
Practice Address - Country:US
Practice Address - Phone:951-493-6925
Practice Address - Fax:951-826-8135
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A19502207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine