Healthcare Provider Details

I. General information

NPI: 1700375953
Provider Name (Legal Business Name): ISAIAH SONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 NW MARKET ST
SEATTLE WA
98107-3743
US

IV. Provider business mailing address

7600 EVERGREEN WAY
EVERETT WA
98203-6421
US

V. Phone/Fax

Practice location:
  • Phone: 206-782-7300
  • Fax: 206-414-7390
Mailing address:
  • Phone: 206-860-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO61292164
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: