Provider Demographics
NPI:1134549009
Name:SOONG, CHENPANG (MD, PHD)
Entity type:Individual
Prefix:
First Name:CHENPANG
Middle Name:
Last Name:SOONG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:SOONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:88 ARSENAL YARDS BLVD APT 505
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-5046
Mailing Address - Country:US
Mailing Address - Phone:205-482-8611
Mailing Address - Fax:
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 280W
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2172
Practice Address - Country:US
Practice Address - Phone:310-829-7678
Practice Address - Fax:310-829-6889
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD460574207R00000X
390200000X
CAA176799207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program