Provider Demographics
NPI:1306031133
Name:SOONG, STEPHEN W (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:W
Last Name:SOONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 WHITSETT AVE # 88
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1615
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:626-458-1429
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30150111NN1001X, 111NS0005X, 111NR0400X
CA11958171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No171100000XOther Service ProvidersAcupuncturist