Sharon Jacob-Soo, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A100287 Issued in CA

Practice address

3860 Calle Fortunada
Ste #210
San Diego, CA 92123-4802

Phone

(858) 309-6303

Fax

(858) 309-6301

NPI assigned

Jun 30, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Csi Medical Group

  • MOHS-Micrographic Surgery Physician
  • San Pedro, CA
  • NPI 1871909804

  Dermatology

  NPD
• Children'S Specialists of San Diego, Inc. (CSSD)

  • Pediatrics Physician
  • San Diego, CA
  • NPI 1801959127
  NPD (past)
• University of Miami

  • Dermatology Physician
  • Miami, FL
  • NPI 1578512125
  NPD (past)
• University of Miami

  • Clinical Medical Laboratory
  • Miami, FL
  • NPI 1790846087
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319500800000",
    "number": "1053349688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 CALLE FORTUNADA",
            "address_2": "STE #210",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234802",
            "telephone_number": "858-309-6303",
            "fax_number": "858-309-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3860 CALLE FORTUNADA",
            "address_2": "STE #210",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234802",
            "telephone_number": "858-309-6303",
            "fax_number": "858-309-6301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB-SOO",
        "first_name": "SHARON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2011-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME89945",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A100287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2704986-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Troika Danielle Jackson
• Vanessa Marie Jackson, P.T.
• William Harold Jackson
• Jacob Health Care Assisted Living
• Jacob Health Care Center LP
• Christopher Alan Jacob, PA-C
• Jessica Marie Jacob, LMFT
• Katherine A Jacob
• Robert B Jacob, D.D.S.
• Simon Jacob

• Dermatology Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.