Healthcare Provider Details

I. General information

NPI: 1316492598
Provider Name (Legal Business Name): ALEX SONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 E UNION HILLS DR STE 115
PHOENIX AZ
85050-3388
US

IV. Provider business mailing address

4045 E UNION HILLS DR STE 115
PHOENIX AZ
85050-3388
US

V. Phone/Fax

Practice location:
  • Phone: 602-368-3448
  • Fax: 602-357-3323
Mailing address:
  • Phone: 602-368-3448
  • Fax: 602-357-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number80245
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number80245
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: