Healthcare Provider Details

I. General information

NPI: 1588893945
Provider Name (Legal Business Name): RUSSELL SOO HOO LEW D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2844 SUMMIT STREET SUITE 202 LOWELL B. DAVIS, DDS, MS
OAKLAND CA
94609-3637
US

IV. Provider business mailing address

P.O. BOX 2162
SAN FRANCISCO CA
94126-2162
US

V. Phone/Fax

Practice location:
  • Phone: 510-834-3414
  • Fax:
Mailing address:
  • Phone: 415-956-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: