Healthcare Provider Details

I. General information

NPI: 1700358116
Provider Name (Legal Business Name): YOUNG EUN SONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2018
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W LA VETA AVE STE 300
ORANGE CA
92868-4246
US

IV. Provider business mailing address

2101 CRESCENT OAK
IRVINE CA
92618-4019
US

V. Phone/Fax

Practice location:
  • Phone: 714-598-1745
  • Fax: 714-941-9539
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95010329
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP95010329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: