Provider Demographics
NPI:1861987422
Name:HUH, SOYEON
Entity type:Individual
Prefix:
First Name:SOYEON
Middle Name:
Last Name:HUH
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 1:6222 WILSHIRE BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5193
Mailing Address - Country:US
Mailing Address - Phone:323-525-1999
Mailing Address - Fax:
Practice Address - Street 1:6222 WILSHIRE BLVD STE 303
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5193
Practice Address - Country:US
Practice Address - Phone:323-525-1999
Practice Address - Fax:323-525-1991
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008412363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty