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General NPI Number Information
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NPI Number | 1629140819
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Entity Type | Individual
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Provider Name | LILLIAN FONG SOOHOO MD
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Gender | Female
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 2490 HOSPITAL DRIVE THE MENKES CLINIC SUITE 201
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-4124
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Country | US
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Telephone | 650-962-4600
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Fax | 650-962-4602
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Provider Business Mailing Address
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Address Line | PO BOX 1497 L
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City | LOS GATOS
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State | CA
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Zip | 95031-1497
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Country | US
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Telephone | 408-836-9030
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Fax | 408-395-8648
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A49205
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License Number State | CA
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