Active NPI
Soontri S Jong, M.D.
- Primary Care Clinic/Center
- Urbana, IL
National Provider Identifier
1396063186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Clinic/Center
- License
- 036-05880
- Practice address
- 407 Pond Ridge LN
Urbana, IL 61802-7117 - Phone
- (217) 954-0595
- NPI assigned
- May 4, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 036-05880 | IL | Primary |
Addresses
Primary practice location
407 Pond Ridge LN
Urbana, IL 61802-7117
Mailing address
407 Pond Ridge LN
Urbana, IL 61802-7117
Phone (217) 954-0595
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-05880 | IL | MD | Primary Care Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1272931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272931200000",
"number": "1396063186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "407 POND RIDGE LN",
"city": "URBANA",
"state": "IL",
"postal_code": "618027117",
"telephone_number": "217-954-0595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "407 POND RIDGE LN",
"city": "URBANA",
"state": "IL",
"postal_code": "618027117",
"telephone_number": "217-954-0595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JONG",
"first_name": "SOONTRI",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-05-04",
"last_updated": "2010-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "261QP2300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Primary Care",
"state": "IL",
"license": "036-05880",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Urbana, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.