Healthcare Provider Details

I. General information

NPI: 1265343271
Provider Name (Legal Business Name): MINSUN JAMES SONG, DDS, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 49TH AVE NE STE D
TACOMA WA
98422-2423
US

IV. Provider business mailing address

4125 49TH AVE NE STE D
TACOMA WA
98422-2423
US

V. Phone/Fax

Practice location:
  • Phone: 253-952-2200
  • Fax: 253-944-9067
Mailing address:
  • Phone: 253-952-2200
  • Fax: 253-944-9067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES SONG
Title or Position: OWNER
Credential:
Phone: 253-474-9509