Healthcare Provider Details

I. General information

NPI: 1174510747
Provider Name (Legal Business Name): LIAN SOUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 N EL DORADO ST SUITE 17
STOCKTON CA
95204-5930
US

IV. Provider business mailing address

1610 N EL DORADO ST SUITE 17
STOCKTON CA
95204-5930
US

V. Phone/Fax

Practice location:
  • Phone: 209-465-5107
  • Fax: 209-465-7653
Mailing address:
  • Phone: 209-465-5107
  • Fax: 209-465-7653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA33597
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA33597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: