Provider Demographics
NPI:1548269707
Name:SOOD, PAWAN K (MD)
Entity type:Individual
Prefix:DR
First Name:PAWAN
Middle Name:K
Last Name:SOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 N CHESTNUT AVE
Mailing Address - Street 2:SUITE NO. 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-412-2333
Mailing Address - Fax:
Practice Address - Street 1:7035 N. CHESTNUT AVENUE
Practice Address - Street 2:SUITE
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-317-2658
Practice Address - Fax:559-317-2658
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192922207R00000X
CAC51821207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01439041Medicaid
CA00C518210Medicaid
CA00C518211Medicare PIN
NYF67665Medicare UPIN
CA00C518210Medicaid
NY00I642Medicare ID - Type Unspecified
NY00I643Medicare ID - Type Unspecified
CAP00454238Medicare PIN
NY01439041Medicaid