Healthcare Provider Details

I. General information

NPI: 1629056254
Provider Name (Legal Business Name): SING WING POON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 S FAIR OAKS AVE SUITE 101
PASADENA CA
91105-2622
US

IV. Provider business mailing address

1044 S FAIR OAKS AVE SUITE 101
PASADENA CA
91105-2622
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-4859
  • Fax: 626-403-0311
Mailing address:
  • Phone: 626-449-4859
  • Fax: 626-403-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberC54567
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number11457
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: