Provider Demographics
NPI:1245806389
Name:WOO, MI SOO (PA-C)
Entity Type:Individual
Prefix:
First Name:MI SOO
Middle Name:
Last Name:WOO
Suffix:
Gender:F
Credentials:PA-C
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6917 STATE HIGHWAY 161 APT 352
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2453
Mailing Address - Country:US
Mailing Address - Phone:469-274-2110
Mailing Address - Fax:
Practice Address - Street 1:4375 BOOTH CALLOWAY RD STE 307
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8364
Practice Address - Country:US
Practice Address - Phone:469-274-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-30
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA14505363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical