Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 21124 | OK |
NPI | 1013912617 |
---|---|
Provider Name | Cheng-Lun Soo |
First Address | Oklahoma City, OK 73109 |
Second Address | Oklahoma City, OK 73159-7042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 17/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100084280A | (05) | OK |
G84583 | (02) | OK |