Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 077659 | GA |
Y | 111NI0900X | Internist | 077659 | GA |
N | 207R00000X | Internist | 245655 | MA |
N | 111NI0900X | Internist | 245655 | MA |
N | 207R00000X | Internist | 8623977-1205 | UT |
N | 111NI0900X | Internist | 8623977-1205 | UT |
NPI | 1003128760 |
---|---|
Provider Name | Soowhan Lah |
First Address | Columbus, GA 31904-6878 |
Second Address | Boston, MA 02135-2907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2010 |
Last Update Date | 16/04/2020 |