Provider Demographics
NPI:1114959822
Name:SOO, CHIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHIA
Middle Name:
Last Name:SOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BESSIE
Other - Middle Name:CHIA
Other - Last Name:SOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 UCLA MEDICAL PLZ
Mailing Address - Street 2:SUITE 465
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-6960
Mailing Address - Country:US
Mailing Address - Phone:310-206-8499
Mailing Address - Fax:310-206-4190
Practice Address - Street 1:200 UCLA MEDICAL PLZ
Practice Address - Street 2:SUITE 465
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-6960
Practice Address - Country:US
Practice Address - Phone:310-206-8499
Practice Address - Fax:310-206-4190
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG801862086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G801860Medicaid
CA00G801860OtherBLUE SHIELD PIN
CAI13968Medicare UPIN
CA00G801860OtherBLUE SHIELD PIN
CAGR784ZMedicare PIN