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General NPI Number Information
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NPI Number | 1053452359
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Entity Type | Individual
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Provider Name | SHARON KYUNGHA SONG D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/09/2011
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Provider Practice Location Address
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Address Line | 49 DAY ST
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City | NORWALK
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State | CT
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Zip | 06854-4901
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Country | US
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Telephone | 203-854-9292
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Fax | 203-854-9437
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Provider Business Mailing Address
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Address Line | 635 MAIN ST ATTN: CREDENTIALING DEPT
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City | MIDDLETOWN
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State | CT
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Zip | 06457-2718
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Country | US
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Telephone | 860-347-6971
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Fax | 860-638-6601
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0520021
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 009859
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License Number State | CT
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