Provider Demographics
NPI:1598447963
Name:SOONG, NICOLE YING WAI
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:YING WAI
Last Name:SOONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CALLAN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4523
Mailing Address - Country:US
Mailing Address - Phone:510-547-2662
Mailing Address - Fax:
Practice Address - Street 1:101 CALLAN AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4584
Practice Address - Country:US
Practice Address - Phone:510-547-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program