Healthcare Provider Details

I. General information

NPI: 1083859888
Provider Name (Legal Business Name): PHILIP SONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 DANVILLE BLVD STE 110
ALAMO CA
94507-1938
US

IV. Provider business mailing address

3201 DANVILLE BLVD STE 110
ALAMO CA
94507-1938
US

V. Phone/Fax

Practice location:
  • Phone: 925-362-0992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA161047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: