Provider Demographics
NPI:1336646132
Name:SO, SIMON KA CHUN (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:KA CHUN
Last Name:SO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4330 BARRANCA PKWY STE 245
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1704
Mailing Address - Country:US
Mailing Address - Phone:949-273-2888
Mailing Address - Fax:949-273-2801
Practice Address - Street 1:4330 BARRANCA PKWY STE 245
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1704
Practice Address - Country:US
Practice Address - Phone:949-273-2888
Practice Address - Fax:949-273-2801
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA166329207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine