MEDICARE: MR. SARUN SOON PA-C

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	363A00000X	Physician Assistant	54212	CA

General Provider Information

NPI Number	:	1972039444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SARUN SOON PA-C

Provider Business Mailing Address
First Line	:	5757 WILSHIRE BLVD STE 660
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3691
Country	:	US
Telephone Number	:	310-717-8071
Fax Number	:

Provider Business Practice Location Address
First Line	:	5757 WILSHIRE BLVD STE 660
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3691
Country	:	US
Telephone Number	:	323-932-9880
Fax Number	:	323-932-9829

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

Provider Enumeration Date	:	05/03/2017
Last Update Date	:	12/10/2025

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