Active NPI
Patricia Soong, MD
- Pediatrics Physician
- San Mateo, CA
National Provider Identifier
1700872132
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- C40027
- Practice address
- 50 S San Mateo Dr
Ste 260
San Mateo, CA 94401-3857 - Phone
- (650) 579-6500
- Fax
- (650) 579-1943
- NPI assigned
- Sep 21, 2005
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | C40027 | CA | Primary |
Addresses
Primary practice location
50 S San Mateo Dr
Ste 260
San Mateo, CA 94401-3857
Mailing address
325 Distel Cir
Los Altos, CA 94022-1408
Phone (650) 652-8720
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00CH00270 | Other | CA | BLUE SHIELD CA |
| ZZZ00797Z | Other | CA | BLUE SHIELD CA -GROUP ID |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C40027 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592784000000",
"number": "1700872132",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 DISTEL CIR",
"city": "LOS ALTOS",
"state": "CA",
"postal_code": "940221408",
"telephone_number": "650-652-8720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 S SAN MATEO DR",
"address_2": "STE 260",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944013857",
"telephone_number": "650-579-6500",
"fax_number": "650-579-1943"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOONG",
"first_name": "PATRICIA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-21",
"last_updated": "2020-06-22",
"certification_date": "2020-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "C40027",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD CA",
"identifier": "00CH00270",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD CA -GROUP ID",
"identifier": "ZZZ00797Z",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.