1235450834 NPI number — DR. VINCENT V. SOUN MD MPH MAJOR

Table of content: DR. VINCENT V. SOUN MD MPH MAJOR (NPI 1235450834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235450834 NPI number — DR. VINCENT V. SOUN MD MPH MAJOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOUN
Provider First Name:
VINCENT
Provider Middle Name:
V.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD MPH MAJOR
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOUN
Provider Other First Name:
VINCENT
Provider Other Middle Name:
VISTH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD MPH MAJOR
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235450834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
529 PINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLTVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92250-1121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-756-3172
Provider Business Mailing Address Fax Number:
760-756-3150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
529 PINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLTVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92250-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-756-3172
Provider Business Practice Location Address Fax Number:
760-756-3150
Provider Enumeration Date:
06/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A129661 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2158741 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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