Healthcare Provider Details

I. General information

NPI: 1548154966
Provider Name (Legal Business Name): MICHAEL H SONG MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5578 LONGLEY LN
RENO NV
89511-1825
US

IV. Provider business mailing address

5578 LONGLEY LN
RENO NV
89511-1825
US

V. Phone/Fax

Practice location:
  • Phone: 775-284-8650
  • Fax:
Mailing address:
  • Phone: 775-284-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL H SONG
Title or Position: MD/PRESIDENT
Credential: MD
Phone: 775-323-6100