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General NPI Number Information
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NPI Number | 1043655640
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Entity Type | Individual
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Provider Name | JIANBO JAMES SONG PHD
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Gender | Male
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Dates
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Enumeration Date | 05/08/2013
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 5755 COTTLE RD BUILDING 2 GENETICS
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City | SAN JOSE
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State | CA
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Zip | 95123-3640
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Country | US
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Telephone | 408-972-3330
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Fax |
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Provider Business Mailing Address
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Address Line | 3145 PURDUE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90066-1405
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Country | US
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Telephone | 310-869-5572
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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 | 207SC0300X
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Taxonomy Name | Clinical Cytogenetics Physician
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License Number | MTO666
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207SG0203X
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Taxonomy Name | Clinical Molecular Genetics Physician
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License Number | MTP288
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License Number State | CA
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