Provider Demographics
NPI:1639243553
Name:SO, TAK YUEN (MD)
Entity type:Individual
Prefix:
First Name:TAK
Middle Name:YUEN
Last Name:SO
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 1:8 LOCH LN
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-1707
Mailing Address - Country:US
Mailing Address - Phone:914-937-2373
Mailing Address - Fax:914-937-2373
Practice Address - Street 1:785 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-1722
Practice Address - Country:US
Practice Address - Phone:718-589-5500
Practice Address - Fax:718-589-1096
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136348208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY968051Medicare ID - Type Unspecified