| Sothy L Pheng Md A Professional Corporation | |
|
2961 Oakberry Ct Fullerton CA 92835-4304 | |
| (978) 551-8088 | |
| Not Available |
| Full Name | Sothy L Pheng Md A Professional Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 2961 Oakberry Ct, Fullerton, California |
| Authorized Official Name and Position | Sothy Lun Pheng (PRESIDENT) |
| Authorized Official Contact | 9785518088 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sothy L Pheng Md A Professional Corporation Po Box 3446 Fullerton CA 92834-3446 Ph: () - | Sothy L Pheng Md A Professional Corporation 2961 Oakberry Ct Fullerton CA 92835-4304 Ph: (978) 551-8088 |
| NPI Number | 1407495815 |
|---|---|
| Provider Enumeration Date | 01/02/2020 |
| Last Update Date | 01/02/2020 |
| Medicare PECOS PAC ID | 1456781855 |
|---|---|
| Medicare Enrollment ID | O20200427002504 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407495815 | NPI | - | NPPES |
| 2086948 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Sothy L Pheng |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083697007 PECOS PAC ID: 9638132186 Enrollment ID: I20150424002047 |
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