Provider Demographics
NPI:1215570783
Name:STEPHEN SOONG HEALTH CENTER
Entity Type:Organization
Organization Name:STEPHEN SOONG HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC, AC
Authorized Official - Phone:626-458-3379
Mailing Address - Street 1:5405 WHITSETT AVE. #88
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607
Mailing Address - Country:US
Mailing Address - Phone:310-594-2162
Mailing Address - Fax:
Practice Address - Street 1:330 N GARFIELD AVE STE 1
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-2400
Practice Address - Country:US
Practice Address - Phone:626-458-3379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service