Healthcare Provider Details

I. General information

NPI: 1427178987
Provider Name (Legal Business Name): MINGXIN SONG LIC. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8850 COLUMBIA 100 PKWY SUITE 206
COLUMBIA MD
21045-2374
US

IV. Provider business mailing address

8850 COLUMBIA 100 PKWY SUITE 206
COLUMBIA MD
21045-2374
US

V. Phone/Fax

Practice location:
  • Phone: 410-715-4292
  • Fax: 410-715-4293
Mailing address:
  • Phone: 410-715-4292
  • Fax: 410-715-4293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU00838
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: