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NPI Code Detail

MEDICARE: DR. FREDDY SOEWIN AW M.D.

MEDICARE: DR. FREDDY SOEWIN AW M.D.
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
1207Q00000XFamily Medicine PhysicianA42328CA

General Provider Information

NPI Number : 1356452114
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FREDDY SOEWIN AW M.D.
Provider Business Mailing Address
First Line : PO BOX 90422
Second Line :
City : CITY OF INDUSTRY
State : CA
Zip : 91715-0422
Country : US
Telephone Number : 626-664-7595
Fax Number :
Provider Business Practice Location Address
First Line : 10300 COMPTON AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90002-3628
Country : US
Telephone Number : 323-564-4331
Fax Number : 323-564-0560
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/08/2007

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