Doctor Name: | DR. YONG SOO SO |
NPI Number: | 1073708046 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | YS037124 |
Business Practice Address: | 22001 Kelly Rd Eastpointe, MI - 480212708 |
Business Phone Number: | 5867780209 |
Business Fax Number: | |
Mailing Address: | 22001 Kelly Rd, EASTPOINTE |
State: | MI |
Postal Code: | 480212708 |
Phone Number: | 5867780209 |
Fax Number: | |
NPI Enumeration Date: | 09/12/2007 |
NPI Last Update Date: | 09/23/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | YS037124 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |