MEDICARE: DR. JOSEPH SOO 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
1	207L00000X	Anesthesiology Physician	A99230	CA
2	207L00000X	Anesthesiology Physician	ME86140	FL

General Provider Information

NPI Number	:	1639160070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH SOO M.D.

Provider Business Mailing Address
First Line	:	11234 ANDERSON ST
Second Line	:	ROOM 2532
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-2804
Country	:	US
Telephone Number	:	619-592-3235
Fax Number	:

Provider Business Practice Location Address
First Line	:	11234 ANDERSON ST
Second Line	:	ROOM 2532
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-2804
Country	:	US
Telephone Number	:	619-592-3235
Fax Number	:

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	01/13/2023

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Directions to “ DR. JOSEPH SOO M.D.” Practice Location

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