Healthcare Provider Details

I. General information

NPI: 1043139827
Provider Name (Legal Business Name): SEUNG YONG SONG DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 2ND AVE STE 101
SEATTLE WA
98121-1262
US

IV. Provider business mailing address

2815 2ND AVE STE 101
SEATTLE WA
98121-1262
US

V. Phone/Fax

Practice location:
  • Phone: 206-225-2882
  • Fax:
Mailing address:
  • Phone: 206-225-2882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SEUNG SONG
Title or Position: OWNER
Credential: DDS
Phone: 951-750-2810