Provider Demographics
NPI:1124197892
Name:LAR, IHN SOUGH (MD)
Entity type:Individual
Prefix:DR
First Name:IHN
Middle Name:SOUGH
Last Name:LAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3010 GRAND CONCOURSE APT L2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1534
Mailing Address - Country:US
Mailing Address - Phone:718-365-8850
Mailing Address - Fax:718-365-8057
Practice Address - Street 1:3010 GRAND CONCOURSE APT L2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1534
Practice Address - Country:US
Practice Address - Phone:718-365-8850
Practice Address - Fax:718-365-8057
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY157642208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00829350Medicaid