Provider Demographics
NPI:1629056254
Name:POON, SING WING (MD)
Entity Type:Individual
Prefix:DR
First Name:SING WING
Middle Name:
Last Name:POON
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 1:1044 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2622
Mailing Address - Country:US
Mailing Address - Phone:626-449-4859
Mailing Address - Fax:626-403-0311
Practice Address - Street 1:1044 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2622
Practice Address - Country:US
Practice Address - Phone:626-449-4859
Practice Address - Fax:626-403-0311
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54567208200000X
NV114572086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCS13693OtherPHARMACY/CDS
NVI42113Medicare UPIN
NVCS13693OtherPHARMACY/CDS