MIN SOO SON – Mental Health Counselor, NPI 1083968002

MIN SOO SON is a healthcare provider. based in Fullerton, California. specializing in CLINICAL SOCIAL WORKER. The NPI Number for MIN SOO SON is 1083968002

Main info

Male
Sole Proprietor
16 Years Of Experience
Accepts Medicare Assignment
Name
MIN SOO SON
NPI
1083968002
Phone
(310) 658-2763
Address
2410 W ORANGETHORPE AVE APT 3
Enumeration Date
29 October 2012
Deactivation Date
27 August 2025
Reactivation Date
25 September 2025
Last Update Date
25 September 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7706641920
Graduation Year
2010 (16 years ago)
PAC ID
6103306212
Group Practice PAC ID
2163561259
Professional Enrollment ID
I20260217003077
Address ID
GA300765826RO401XXLNXX300
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience31
Completeness85
Years active:13State licenses:0Digital endpointsOther names

4,987 CLINICAL SOCIAL WORKER in CA

Provider Addresses for MIN SOO SON

  • 2410 W ORANGETHORPE AVE APT 3

    FULLERTON, CA 928334260

    Phone: (310) 658-2763

    Type: Mailing

  • 3727 W 6TH ST STE 210

    LOS ANGELES, CA 900205108

    Phone: (213) 637-1080

    Fax: (213) 637-1075

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2026-02-17

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20260217003077IClinical Social WorkerGATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 92833)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2163561259View full group profile
NameSpecialtyState
Mental Health CounselorOK
Nurse PractitionerGA
Mental Health CounselorGA
-NC
Clinical Social WorkerGA
Nurse PractitionerGA
P S Y C H I A T R YGA
Clinical Social WorkerGA
Clinical Social WorkerGA
Nurse PractitionerGA

Reviews

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Frequently asked questions

What federal number belongs to MIN SOO SON?
The federal identifier for MIN SOO SON is NPI 1083968002.
Is MIN SOO SON's NPI currently valid?
The extract we use shows MIN SOO SON as active.
What does MIN SOO SON treat or focus on?
Patients typically see MIN SOO SON under the specialty Mental Health Counselor. Clinical services aligned with this taxonomy classification.
Where is MIN SOO SON's primary listing?
We display Fullerton, California because that is what the record indicates for MIN SOO SON.
Is MIN SOO SON a real provider?
This page reflects official NPPES data for NPI 1083968002. Always confirm identity and privileges with the practice and licensing boards.

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