Healthcare Provider Details

I. General information

NPI: 1831027259
Provider Name (Legal Business Name): SE SONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1500 DUARTE RD
DUARTE CA
91010-3012
US

IV. Provider business mailing address

2806 ORCHID CT
ARCADIA CA
91006-5551
US

V. Phone/Fax

Practice location:
  • Phone: 626-218-1554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number62971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: