| Yong Soo So, M.d., P.c. | |
|
22001 Kelly Rd Eastpointe MI 48021-2708 | |
| (586) 778-0209 | |
| (586) 778-0202 |
| Full Name | Yong Soo So, M.d., P.c. |
|---|---|
| Speciality | General Practice |
| Location | 22001 Kelly Rd, Eastpointe, Michigan |
| Authorized Official Name and Position | Yong Soo So (PRESIDENT) |
| Authorized Official Contact | 5867780209 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Yong Soo So, M.d., P.c. 22001 Kelly Rd Eastpointe MI 48021-2708 Ph: (586) 778-0209 | Yong Soo So, M.d., P.c. 22001 Kelly Rd Eastpointe MI 48021-2708 Ph: (586) 778-0209 |
| NPI Number | 1356405294 |
|---|---|
| Provider Enumeration Date | 12/21/2006 |
| Last Update Date | 04/20/2008 |
| Medicare PECOS PAC ID | 1658354089 |
|---|---|
| Medicare Enrollment ID | O20040608001028 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356405294 | NPI | - | NPPES |
| 4641238 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | YS037124 (Michigan) | Primary |
| Provider Name | Yong So |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1073708046 PECOS PAC ID: 2264334465 Enrollment ID: I20040127000019 |
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