NPIMap

Individual provider Active NPI

Lillian Fong Soohoo, MD

  • Specialist
  • Mountain View, CA
National Provider Identifier
1629140819
Registry record updated Oct 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A49205 Issued in CA
Practice address
2490 Hospital Drive
The Menkes Clinic Suite 201
Mountain View, CA 94040-4124
Phone
(650) 962-4600
Fax
(650) 962-4602
NPI assigned
Nov 14, 2006
Last updated
Oct 1, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X A49205 CA Primary

Addresses

Primary practice location

2490 Hospital Drive
The Menkes Clinic Suite 201
Mountain View, CA 94040-4124

Mailing address

PO Box 1497
L
Los Gatos, CA 95031-1497
Phone (408) 836-9030

Other identifiers 1

IdentifierTypeStateIssuer
A49205OtherCAMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041108000363 CA Practitioner - Dermatology 6103889548 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

355 Lennon LN
Suite 255
Walnut Creek, CA 94598-2496
Phone (925) 932-7704

Merit-based Incentive Payment System (MIPS)

Final score
99.15 of 100Reported as group
Promoting interoperability
99
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions339
Skin biopsy127

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A49205CAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Golden State Dermatology Associates, Inc. CurrentSince Mar 7, 2020 Accepting new patients
Golden State Dermatology Associates Inc Dermatology CurrentSince Mar 7, 2020 Accepting new patients
El Camino Hospital Past Accepting new patients
California Skin Institute, a Medical Corporation Dermatology Past Accepting new patients
Stanford Hospital and Clinics Past Accepting new patients
Good Samaritan Hospital, L.P. Past Accepting new patients
LPCH Medical Group Div of Lucile Past Accepting new patients
Stanford Health Care Dermatology Past Accepting new patients
Lucile Salter Packard Children's Hospital at Stanford Past Accepting new patients
Sutter Bay Medical Foundation Past Accepting new patients

Locations

1200 Central Blvd
Ste D
Brentwood, CA 94513
Phone (925) 308-9510

555 Knowles Dr
Ste 220
Los Gatos, CA 95032
Phone (408) 378-5887

2490 Hospital Dr
Ste 201
Mountain View, CA 94040
Phone (650) 285-4661

355 Lennon Ln
Ste 255
Walnut Creek, CA 94598
Phone (925) 932-7704

370 N Wiget Ln
Ste 250
Walnut Creek, CA 94598
Phone (925) 278-7592

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 10

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

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222819200000",
    "number": "1629140819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1497",
            "address_2": "L",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950311497",
            "telephone_number": "408-836-9030",
            "fax_number": "408-395-8648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 HOSPITAL DRIVE",
            "address_2": "THE MENKES CLINIC SUITE 201",
            "city": "MOUNTAIN VIEW",
            "state": "CA",
            "postal_code": "940404124",
            "telephone_number": "650-962-4600",
            "fax_number": "650-962-4602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOOHOO",
        "first_name": "LILLIAN",
        "middle_name": "FONG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2008-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A49205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "A49205",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain View, CA

Sources for this page

Verify at the official NPI Registry.