Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A144607 | CA |
NPI | 1023405727 |
---|---|
Provider Name | Grace Kim Sohn |
First Address | Walnut Creek, CA 94598-2496 |
Second Address | Walnut Creek, CA 94598-2496 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2015 |
Last Update Date | 27/08/2020 |