Healthcare Provider Details

I. General information

NPI: 1619155041
Provider Name (Legal Business Name): JOSEPH K SONG MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7571 COMMONWEALTH AVE
BUENA PARK CA
90621-2315
US

IV. Provider business mailing address

7571 COMMONWEALTH AVE
BUENA PARK CA
90621-2315
US

V. Phone/Fax

Practice location:
  • Phone: 714-539-2600
  • Fax: 714-539-2611
Mailing address:
  • Phone: 714-539-2600
  • Fax: 714-539-2611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG69832
License Number StateCA

VIII. Authorized Official

Name: DR. JOSEPH K SONG
Title or Position: OWNER
Credential: MD
Phone: 714-539-2600