Provider Demographics
NPI:1760912570
Name:DR SOO UHM LICENSED PSYCHOLOGIST INC
Entity Type:Organization
Organization Name:DR SOO UHM LICENSED PSYCHOLOGIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOO
Authorized Official - Middle Name:
Authorized Official - Last Name:UHM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-689-9441
Mailing Address - Street 1:1010 S EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 S EL CAMINO REAL STE A
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2802
Practice Address - Country:US
Practice Address - Phone:415-689-9441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28657103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty