Provider Demographics
NPI:1023182763
Name:SOOD, OM PARKASH (MD)
Entity Type:Individual
Prefix:
First Name:OM
Middle Name:PARKASH
Last Name:SOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12998 HESPERIA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8316
Mailing Address - Country:US
Mailing Address - Phone:760-955-2828
Mailing Address - Fax:760-955-2488
Practice Address - Street 1:12675 HESPERIA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5878
Practice Address - Country:US
Practice Address - Phone:760-955-2828
Practice Address - Fax:760-955-2488
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62638207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A626380Medicaid
00A626380Medicare ID - Type Unspecified
G65967Medicare UPIN