1003128760 NPI number — SOOWHAN LAH M.D.

Table of content: SOOWHAN LAH M.D. (NPI 1003128760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003128760 NPI number — SOOWHAN LAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAH
Provider First Name:
SOOWHAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003128760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2122 MANCHESTER EXPY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31904-6878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-320-2773
Provider Business Mailing Address Fax Number:
706-596-4226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
736 CAMBRIDGE ST
Provider Second Line Business Practice Location Address:
INTERNAL MEDICINE RESIDENCY PROGRAM - MAILBOX #13
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02135-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-886-9722
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  245655 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 8623977-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 077659 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)