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General NPI Number Information
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NPI Number | 1194854596
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Entity Type | Individual
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Provider Name | SOPHIA SUHYUN SONG L.AC
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Gender | Female
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Dates
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Enumeration Date | 03/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 984 N BROADWAY STE 400A
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City | YONKERS
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State | NY
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Zip | 10701-1320
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Country | US
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Telephone | 914-329-6657
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Fax | 914-423-2378
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Provider Business Mailing Address
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Address Line | 2575 PALISADE AVE APT 4D
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City | BRONX
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State | NY
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Zip | 10463-6126
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Country | US
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Telephone | 347-202-8985
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Fax | 347-202-8985
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1407
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 25MZ00023800
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 0121000158
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License Number State | VA
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