Healthcare Provider Details

I. General information

NPI: 1679720221
Provider Name (Legal Business Name): YOUNG-SOO SONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: YOUNG-SOO SONG M.D.

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD LAHEY HOSPITAL AND MEDICAL CENTER
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

41 MALL RD LAHEY HOSPITAL AND MEDICAL CENTER
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8430
  • Fax: 781-744-5397
Mailing address:
  • Phone: 781-744-8430
  • Fax: 781-744-5397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number257013
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: