Provider Demographics
NPI:1013912617
Name:SOO, CHENG-LUN (MD)
Entity Type:Individual
Prefix:
First Name:CHENG-LUN
Middle Name:
Last Name:SOO
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 1:13700 S WESTERN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7006
Mailing Address - Country:US
Mailing Address - Phone:405-806-7246
Mailing Address - Fax:405-616-2670
Practice Address - Street 1:13700 S WESTERN AVE STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-7006
Practice Address - Country:US
Practice Address - Phone:405-631-4263
Practice Address - Fax:405-982-1583
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21124208VP0014X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100084280AMedicaid
OKG84583Medicare UPIN