Healthcare Provider Details

I. General information

NPI: 1154070613
Provider Name (Legal Business Name): WEILIN SONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 WALNUT ST STE 1020
PHILADELPHIA PA
19107-5180
US

IV. Provider business mailing address

840 WALNUT ST STE 1020
PHILADELPHIA PA
19107-5180
US

V. Phone/Fax

Practice location:
  • Phone: 800-331-6634
  • Fax:
Mailing address:
  • Phone: 800-331-6634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD493728
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: