Provider Demographics
NPI:1780610345
Name:SO, KIRK C (MD)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:C
Last Name:SO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2125 OAK GROVE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2536
Mailing Address - Country:US
Mailing Address - Phone:925-296-7150
Mailing Address - Fax:925-296-7171
Practice Address - Street 1:2125 OAK GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2536
Practice Address - Country:US
Practice Address - Phone:925-296-7150
Practice Address - Fax:925-296-7171
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA874562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A8745617Medicare PIN
CAP00227315Medicare PIN
CAI28094Medicare UPIN
CA00A874562Medicare PIN
CA00A8745621Medicare PIN
CA00A745619Medicare PIN
CA00A874560Medicare PIN
CA00A874567Medicare PIN
CAP00282772Medicare PIN
CA00A8745612Medicare PIN
CA00A8745613Medicare PIN
CA00A8745615Medicare PIN
CA00A8745618Medicare PIN
CA00A8745611Medicare PIN
CA00A8745620Medicare PIN
CA00A874561Medicare PIN
CA00A8745610Medicare PIN
CA00A874566Medicare PIN
CA00A874569Medicare PIN
CAP00410125Medicare PIN
CA00A8745616Medicare PIN
CA00A8745622Medicare PIN
CA00A8745614Medicare PIN
CA00A874565Medicare PIN
CA00A874568Medicare PIN