Healthcare Provider Details

I. General information

NPI: 1801762208
Provider Name (Legal Business Name): MINSUN JAMES SONG, DDS, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7808 PACIFIC AVE STE 5
TACOMA WA
98408-7039
US

IV. Provider business mailing address

119 191ST STREET CT E
SPANAWAY WA
98387-4604
US

V. Phone/Fax

Practice location:
  • Phone: 253-474-9509
  • Fax: 253-314-5843
Mailing address:
  • Phone:
  • Fax:

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: MINSUN JAMES SONG
Title or Position: OWNER
Credential: DDS
Phone: 253-993-6376