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NPI Code Detail

MEDICARE: DORA H. SO M.D.

MEDICARE: DORA H. SO 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
1207R00000XInternal Medicine PhysicianC54106CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2462213OTHERTUFTS
3412496OTHERRIBCHIP
4J28938OTHERMAMABC
596056OTHERFALLON
6AA38564OTHERHPHC
75276624OTHERCIGNA
8000000030969OTHERMABMC HEALTHNET

General Provider Information

NPI Number : 1700807609
Entity Type Code : Individual
Provider Name (Legal Business Name) : DORA H. SO M.D.
Provider Business Mailing Address
First Line : 5767 W CENTURY BLVD STE 400
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-5631
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4323 W RIVERSIDE DR
Second Line :
City : BURBANK
State : CA
Zip : 91505-4044
Country : US
Telephone Number : 818-556-2700
Fax Number : 818-295-3450
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2006
Last Update Date : 12/12/2019

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