Healthcare Provider Details

I. General information

NPI: 1255820999
Provider Name (Legal Business Name): JEE HEY SONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 COTTLE RD BLDG 21
SAN JOSE CA
95123-3600
US

IV. Provider business mailing address

5755 COTTLE RD BLDG 21
SAN JOSE CA
95123-3600
US

V. Phone/Fax

Practice location:
  • Phone: 408-972-3300
  • Fax:
Mailing address:
  • Phone: 408-972-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberA198548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: