Healthcare Provider Details

I. General information

NPI: 1790796811
Provider Name (Legal Business Name): WAYNE SOONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WHEELING ST
AURORA CO
80045-7211
US

IV. Provider business mailing address

1700 WHEELING ST
AURORA CO
80045-7211
US

V. Phone/Fax

Practice location:
  • Phone: 720-723-6230
  • Fax:
Mailing address:
  • Phone: 720-723-6230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number036-111374
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036-111374
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: