Provider Demographics
NPI:1427865377
Name:NA, SOHYEON
Entity type:Individual
Prefix:
First Name:SOHYEON
Middle Name:
Last Name:NA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19535 NORDHOFF ST APT 35-523
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-7403
Mailing Address - Country:US
Mailing Address - Phone:213-670-3758
Mailing Address - Fax:
Practice Address - Street 1:19535 NORDHOFF ST APT 35-523
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-7403
Practice Address - Country:US
Practice Address - Phone:213-670-3758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95384159163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse