Healthcare Provider Details

I. General information

NPI: 1316985633
Provider Name (Legal Business Name): HENRY K POON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 FOURTH AVE, STE 200 US HEALTHWORKS
SAN DIEGO CA
92103
US

IV. Provider business mailing address

2621 W CANYON AVE APARTMENT #421
SAN DIEGO CA
92123-4732
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-9610
  • Fax:
Mailing address:
  • Phone: 619-297-9610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number153894
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: