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General NPI Number Information
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NPI Number | 1356405294
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Entity Type | Organization
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Legal Business Name | YONG SOO SO, M.D., P.C.
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 22001 KELLY RD
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City | EASTPOINTE
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State | MI
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Zip | 48021-2708
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Country | US
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Telephone | 586-778-0209
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Fax | 586-778-0202
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Provider Business Mailing Address
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Address Line | 22001 KELLY RD
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City | EASTPOINTE
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State | MI
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Zip | 48021-2708
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Country | US
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Telephone | 586-778-0209
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Fax | 586-778-0202
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YONG SOO SO
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Credential | M.D.
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Telephone | 586-778-0209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | YS037124
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License Number State | MI
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