Provider Demographics
NPI:1669603205
Name:LEO SOO HOO, M.A., INC.
Entity type:Organization
Organization Name:LEO SOO HOO, M.A., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOO HOO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA
Authorized Official - Phone:702-369-9706
Mailing Address - Street 1:9244 EVERGREEN CANYON DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134
Mailing Address - Country:US
Mailing Address - Phone:702-363-8460
Mailing Address - Fax:
Practice Address - Street 1:4760 S. PECOS ROAD
Practice Address - Street 2:SUITE 103-27
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121
Practice Address - Country:US
Practice Address - Phone:702-369-9706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEO SOO HOO, M.A., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVHAS238237600000X
NVA-113231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386641389Medicare UPIN