Healthcare Provider Details

I. General information

NPI: 1578677860
Provider Name (Legal Business Name): SEUNG-YIL SONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: S.Y. THOMAS SONG M.D.

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7930 FROST ST STE 405
SAN DIEGO CA
92123-2759
US

IV. Provider business mailing address

7930 FROST ST STE 405
SAN DIEGO CA
92123-2759
US

V. Phone/Fax

Practice location:
  • Phone: 858-571-2811
  • Fax: 858-571-2814
Mailing address:
  • Phone: 858-571-2811
  • Fax: 858-571-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA25278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: