Healthcare Provider Details

I. General information

NPI: 1902508195
Provider Name (Legal Business Name): ALBERT SANGHOON SONG MD/PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR # MC8756
SAN DIEGO CA
92103-1911
US

IV. Provider business mailing address

200 W ARBOR DR # MC8756
SAN DIEGO CA
92103-1911
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-3534
  • Fax:
Mailing address:
  • Phone: 619-543-3534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA210707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: