Provider Demographics
NPI:1659600799
Name:SO, JEFFREY JOON-BUM (MS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JOON-BUM
Last Name:SO
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Gender:M
Credentials:MS, PA-C
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Mailing Address - Street 1:421 N RODEO DR
Mailing Address - Street 2:TERRACE LEVEL, NORTH, 2ND FLOOR
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4500
Mailing Address - Country:US
Mailing Address - Phone:310-274-5372
Mailing Address - Fax:310-274-5380
Practice Address - Street 1:421 N RODEO DR
Practice Address - Street 2:TERRACE LEVEL, NORTH, 2ND FLOOR
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4500
Practice Address - Country:US
Practice Address - Phone:310-274-5372
Practice Address - Fax:310-274-5380
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
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Provider Licenses
StateLicense IDTaxonomies
CAPA20727363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical