MEDICARE: MR. LEO SOOHOO M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	A-113	NV

General Provider Information

NPI Number	:	1386641389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEO SOOHOO M.A.

Provider Business Mailing Address
First Line	:	9244 EVERGREEN CANYON DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6059
Country	:	US
Telephone Number	:	702-369-9706
Fax Number	:

Provider Business Practice Location Address
First Line	:	4760 S PECOS RD
Second Line	:	#103-27
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5828
Country	:	US
Telephone Number	:	702-369-9706
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/15/2009

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