Provider Demographics
NPI:1497792188
Name:SOONG, JOHN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:SOONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ALA MOANA BLVD
Mailing Address - Street 2:TOWER 4, SUITE 510
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4920
Mailing Address - Country:US
Mailing Address - Phone:808-521-9551
Mailing Address - Fax:808-536-3008
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2402
Practice Address - Country:US
Practice Address - Phone:808-521-9551
Practice Address - Fax:808-536-3008
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-22192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD2219-02OtherMDX HAWAII
HI039379Medicaid
HI01WCBDH05Medicare PIN
HIE50834Medicare UPIN