Provider Demographics
NPI:1275883928
Name:SOPHIA 600 MEDI GROUP INC.
Entity type:Organization
Organization Name:SOPHIA 600 MEDI GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:HANA
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-285-2574
Mailing Address - Street 1:14617 NORTHERN BLVD # 1F
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3693
Mailing Address - Country:US
Mailing Address - Phone:917-285-2574
Mailing Address - Fax:917-285-2591
Practice Address - Street 1:14617 NORTHERN BLVD # 1F
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3693
Practice Address - Country:US
Practice Address - Phone:917-285-2574
Practice Address - Fax:917-285-2591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care