Provider Demographics
NPI:1063118966
Name:SOHN, YOUNG SAM (LAC)
Entity type:Individual
Prefix:
First Name:YOUNG SAM
Middle Name:
Last Name:SOHN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16051 COMPRINT CIR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1320
Mailing Address - Country:US
Mailing Address - Phone:301-893-4124
Mailing Address - Fax:
Practice Address - Street 1:16051 COMPRINT CIR
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1320
Practice Address - Country:US
Practice Address - Phone:301-893-4124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02963171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist