Healthcare Provider Details

I. General information

NPI: 1336934074
Provider Name (Legal Business Name): STEVEN SONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S 11TH ST
PHILADELPHIA PA
19107-4949
US

IV. Provider business mailing address

3737 CHESTNUT ST APT 2501
PHILADELPHIA PA
19104-7723
US

V. Phone/Fax

Practice location:
  • Phone: 215-503-3876
  • Fax: 215-955-2519
Mailing address:
  • Phone: 604-423-5033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: