1629140819 NPI number — LILLIAN FONG SOOHOO MD

Table of content: LILLIAN FONG SOOHOO MD (NPI 1629140819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629140819 NPI number — LILLIAN FONG SOOHOO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOOHOO
Provider First Name:
LILLIAN
Provider Middle Name:
FONG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629140819
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1497
Provider Second Line Business Mailing Address:
L
Provider Business Mailing Address City Name:
LOS GATOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95031-1497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-836-9030
Provider Business Mailing Address Fax Number:
408-395-8648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2490 HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
THE MENKES CLINIC SUITE 201
Provider Business Practice Location Address City Name:
MOUNTAIN VIEW
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94040-4124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-962-4600
Provider Business Practice Location Address Fax Number:
650-962-4602
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A49205 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A49205 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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