Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | 30150 | CA |
Y | 111NR0400X | Rehabilitation Chiropractor | 30150 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 30150 | CA |
NPI | 1306031133 |
---|---|
Provider Name | Dr. Stephen W Soong |
First Address | Valley Village, CA 91607-1615 |
Second Address | Alhambra, CA 91801-2400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2007 |
Last Update Date | 25/09/2018 |