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General NPI Number Information
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NPI Number | 1023456753
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Entity Type | Individual
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Provider Name | JIN SONG D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 04/15/2024
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Provider Practice Location Address
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Address Line | 2611 S QUILLAN PL STE 110
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City | KENNEWICK
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State | WA
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Zip | 99338-1899
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Country | US
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Telephone | 509-585-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 2611 S QUILLAN PL STE 110
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City | KENNEWICK
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State | WA
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Zip | 99338-1899
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Country | US
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Telephone | 509-585-5437
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 29005
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | DE61516940
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE61516940
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License Number State | WA
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