Healthcare Provider Details

I. General information

NPI: 1891281036
Provider Name (Legal Business Name): MEJAH SOONG PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 WATER ST STE 107
PORT TOWNSEND WA
98368-6728
US

IV. Provider business mailing address

1136 WATER ST STE 107
PORT TOWNSEND WA
98368-6728
US

V. Phone/Fax

Practice location:
  • Phone: 360-499-6750
  • Fax:
Mailing address:
  • Phone: 360-499-6750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00048978
License Number StateWA

VIII. Authorized Official

Name: MEJAH SOONG
Title or Position: OWNER
Credential: MD
Phone: 360-499-6750