MEDICARE: JEEEUN SONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	83278	CA
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	83278	CA

General Provider Information

NPI Number	:	1134721087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEEEUN SONG

Provider Business Mailing Address
First Line	:	1634 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-4227
Country	:	US
Telephone Number	:	213-341-1411
Fax Number	:

Provider Business Practice Location Address
First Line	:	1634 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-4227
Country	:	US
Telephone Number	:	213-341-1411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2020
Last Update Date	:	05/16/2025

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Directions to “ JEEEUN SONG ” Practice Location

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