Provider Demographics
NPI:1255513479
Name:JAMES Y SOONG M.D., APC
Entity type:Organization
Organization Name:JAMES Y SOONG M.D., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SOONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-771-3040
Mailing Address - Street 1:909 HYDE ST
Mailing Address - Street 2:SUITE 234
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4822
Mailing Address - Country:US
Mailing Address - Phone:415-771-3040
Mailing Address - Fax:415-885-6291
Practice Address - Street 1:909 HYDE ST
Practice Address - Street 2:SUITE 234
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4822
Practice Address - Country:US
Practice Address - Phone:415-771-3040
Practice Address - Fax:415-885-6291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30656174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7529118Medicaid
CAA44504Medicare UPIN
CA7529118Medicaid