Basic Information
| Provider Information | |||||||||
| NPI: | 1295829836 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOONG | ||||||||
| FirstName: | VERA | ||||||||
| MiddleName: | Y. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 817 PRINCETON AVE SW | ||||||||
| Address2: | POB III; SUITE 302 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352111333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057816995 | ||||||||
| FaxNumber: | 2057818783 | ||||||||
| Practice Location | |||||||||
| Address1: | 817 PRINCETON AVENUE S.W. | ||||||||
| Address2: | POB II; SUITE 302 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057816995 | ||||||||
| FaxNumber: | 2057818783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 06/01/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 13000 | AL | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 000092979 | 05 | AL | MEDICAID |