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General NPI Number Information
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NPI Number | 1104634963
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Entity Type | Organization
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Legal Business Name | NA YOUNG SONG, D.O., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/26/2024
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 2001 S BARRINGTON AVE STE 111
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City | LOS ANGELES
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State | CA
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Zip | 90025-5337
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Country | US
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Telephone | 424-625-8897
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 S BARRINGTON AVE STE 111
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City | LOS ANGELES
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State | CA
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Zip | 90025-5337
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Country | US
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Telephone | 424-625-8897
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Fax |
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Authorized Official
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Title or Position | CEO, CFO, SECRETARY
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Name | DR. NA YOUNG SONG
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Credential | DO
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Telephone | 424-625-8897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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