Provider Demographics
NPI:1659416584
Name:SO, VANNARITH (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:VANNARITH
Middle Name:
Last Name:SO
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 N BELLFLOWER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1777 N BELLFLOWER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4013
Practice Address - Country:US
Practice Address - Phone:562-986-6138
Practice Address - Fax:562-986-6382
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA85885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine