Healthcare Provider Details

I. General information

NPI: 1083726905
Provider Name (Legal Business Name): SANDY SOONCHUNG KOH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SOONCHUNG S KOH M.D.

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 PECK RD
EL MONTE CA
91733-2434
US

IV. Provider business mailing address

2727 PECK RD
EL MONTE CA
91733-2434
US

V. Phone/Fax

Practice location:
  • Phone: 626-350-2196
  • Fax:
Mailing address:
  • Phone: 626-350-2196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00A345830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: