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Individual
SOO YOUN SI
Active
Individual
SOO YOUN SI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DDS100686
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XZA994688104
BLUE CROSS, BLUE SHIELD
MN
Enumeration date
10/04/2016
Last updated
10/04/2016
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