Provider Demographics
NPI:1558564898
Name:SON, DON DONGSOO (MD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:DONGSOO
Last Name:SON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DONG SOO
Other - Middle Name:
Other - Last Name:SON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:408 S BEACH BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1853
Mailing Address - Country:US
Mailing Address - Phone:714-527-2240
Mailing Address - Fax:714-527-2328
Practice Address - Street 1:408 S BEACH BLVD STE 206
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1853
Practice Address - Country:US
Practice Address - Phone:714-527-2240
Practice Address - Fax:714-527-2328
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121306207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500610021Medicaid
CAGF925ZOtherMEDICARE PIN-855I
CA6977240Medicaid
CAGF901AMedicare PIN