Healthcare Provider Details

I. General information

NPI: 1487035895
Provider Name (Legal Business Name): JOHANNA SHEU SONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOHANNA SONG

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 DUBLIN BLVD
DUBLIN CA
94568-3113
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 510-498-2374
  • Fax:
Mailing address:
  • Phone: 510-498-2374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA162362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: