MEDICARE: ANDREW J. SO PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	PA17558	CA
2	363AS0400X	Surgical Physician Assistant	PA17558	CA

General Provider Information

NPI Number	:	1093749533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW J. SO PA

Provider Business Mailing Address
First Line	:	3000 W MACARTHUR BLVD STE 600
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6982
Country	:	US
Telephone Number	:	949-216-3244
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 W MACARTHUR BLVD STE 600
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6982
Country	:	US
Telephone Number	:	949-216-3244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	01/17/2024

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