Provider Demographics
NPI:1972039444
Name:SOON, SARUN (PA-C)
Entity type:Individual
Prefix:MR
First Name:SARUN
Middle Name:
Last Name:SOON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 WILSHIRE BLVD STE 660
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3691
Mailing Address - Country:US
Mailing Address - Phone:310-717-8071
Mailing Address - Fax:
Practice Address - Street 1:5757 WILSHIRE BLVD STE 660
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3691
Practice Address - Country:US
Practice Address - Phone:323-932-9880
Practice Address - Fax:323-932-9829
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54212363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant