Provider Demographics
NPI:1588983100
Name:C L SOO MD PC
Entity type:Organization
Organization Name:C L SOO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHENG-LUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-255-0309
Mailing Address - Street 1:3705 W MEMORIAL RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1512
Mailing Address - Country:US
Mailing Address - Phone:405-775-9350
Mailing Address - Fax:405-775-9360
Practice Address - Street 1:1044 SW 44TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3613
Practice Address - Country:US
Practice Address - Phone:405-631-4263
Practice Address - Fax:405-631-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21124207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty