Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | G70336 | CA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD050543L | PA |
NPI | 1053394676 |
---|---|
Provider Name | Sophia Sung Hom |
First Address | Pgh, PA 15224 |
Second Address | Pgh, PA 15224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 13/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G703360 | (05) | CA |
E70487 | (02) | CA |
G70336 | CALIFORNIA STATE LICENSE (01) | CA |