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General NPI Number Information
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NPI Number | 1134740889
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Entity Type | Individual
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Provider Name | SAMUEL SONG
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Gender | Male
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 2600 SW HOLDEN ST
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City | SEATTLE
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State | WA
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Zip | 98126-3505
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Country | US
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Telephone | 425-409-7725
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Fax |
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Provider Business Mailing Address
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Address Line | 16445 169TH ST SE
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City | MONROE
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State | WA
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Zip | 98272-2903
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Country | US
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Telephone |
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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 | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State |
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