Provider Demographics
NPI:1053394676
Name:HOM, SOPHIA SUNG (MD)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:SUNG
Last Name:HOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 PENN AVENUE
Mailing Address - Street 2:5TH FL. FACULTY PAVILION
Mailing Address - City:PGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224
Mailing Address - Country:US
Mailing Address - Phone:412-692-7626
Mailing Address - Fax:412-692-5817
Practice Address - Street 1:4401 PENN AVENUE
Practice Address - Street 2:5TH FL. FACULTY PAVILION
Practice Address - City:PGH
Practice Address - State:PA
Practice Address - Zip Code:15224
Practice Address - Country:US
Practice Address - Phone:412-692-7626
Practice Address - Fax:412-692-5817
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70336208G00000X
PAMD050543L208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G703360Medicaid
CAG70336OtherCALIFORNIA STATE LICENSE
CAG70336OtherCALIFORNIA STATE LICENSE
CAG70336Medicare ID - Type UnspecifiedMEDICARE PPIN