Provider Demographics
NPI:1003586801
Name:SIMON KA CHUN SO, M.D., PROFESSIONAL MEDICAL INC.
Entity Type:Organization
Organization Name:SIMON KA CHUN SO, M.D., PROFESSIONAL MEDICAL INC.
Other - Org Name:SYNERGY PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:KA CHUN
Authorized Official - Last Name:SO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-273-2888
Mailing Address - Street 1:4330 BARRANCA PKWY STE 245
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1704
Mailing Address - Country:US
Mailing Address - Phone:949-273-2888
Mailing Address - Fax:949-273-2801
Practice Address - Street 1:4330 BARRANCA PKWY STE 245
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1704
Practice Address - Country:US
Practice Address - Phone:949-273-2888
Practice Address - Fax:949-273-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty