Provider Demographics
NPI:1740276187
Name:SOONG CHAPMAN AND BEYMER
Entity type:Organization
Organization Name:SOONG CHAPMAN AND BEYMER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GROUP PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:650-579-6500
Mailing Address - Street 1:50 S SAN MATEO DR
Mailing Address - Street 2:STE 260
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401
Mailing Address - Country:US
Mailing Address - Phone:650-579-6500
Mailing Address - Fax:650-579-1943
Practice Address - Street 1:50 S SAN MATEO DR
Practice Address - Street 2:STE 260
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401
Practice Address - Country:US
Practice Address - Phone:650-579-6500
Practice Address - Fax:650-579-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00797ZOtherBLUE SHIELD CA GROUP ID