Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | G80186 | CA |
NPI | 1114959822 |
---|---|
Provider Name | Dr. Chia Soo |
First Address | Los Angeles, CA 90095-6960 |
Second Address | Los Angeles, CA 90095-6960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 23/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G801860 | (05) | CA |
00G801860 | BLUE SHIELD PIN (01) | CA |
I13968 | (02) | CA |