Healthcare Provider Details

I. General information

NPI: 1669603205
Provider Name (Legal Business Name): LEO SOO HOO, M.A., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 S. PECOS ROAD SUITE 103-27
LAS VEGAS NV
89121
US

IV. Provider business mailing address

9244 EVERGREEN CANYON DRIVE
LAS VEGAS NV
89134
US

V. Phone/Fax

Practice location:
  • Phone: 702-369-9706
  • Fax:
Mailing address:
  • Phone: 702-363-8460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-113
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHAS238
License Number StateNV

VIII. Authorized Official

Name: LEO SOO HOO JR.
Title or Position: PRESIDENT/AUDIOLOGIST
Credential: M.A.
Phone: 702-369-9706