Provider Demographics
NPI:1770722159
Name:SOOHOO, GEORGE MANE (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MANE
Last Name:SOOHOO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13200 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3253
Mailing Address - Country:US
Mailing Address - Phone:562-868-9979
Mailing Address - Fax:562-868-4761
Practice Address - Street 1:13200 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3253
Practice Address - Country:US
Practice Address - Phone:562-868-9979
Practice Address - Fax:562-868-4761
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA033377122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist