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General NPI Number Information
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NPI Number | 1114143211
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Entity Type | Individual
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Provider Name | SONG SIAMENG JANN PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 10/29/2023
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Provider Practice Location Address
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Address Line | 5131 NELLIE CT
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-5132
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Country | US
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Telephone | 213-841-4181
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Fax |
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Provider Business Mailing Address
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Address Line | 13795 NIGHTINGALE CT
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City | EASTVALE
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State | CA
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Zip | 92880-5513
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Country | US
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Telephone | 909-684-0025
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA14795
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License Number State | CA
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