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General NPI Number Information
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NPI Number | 1235932708
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Entity Type | Organization
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Legal Business Name | JONATHAN SONG
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 9630 E SHEA BLVD # AZ
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6267
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Country | US
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Telephone | 480-360-2039
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Fax | 909-265-9445
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Provider Business Mailing Address
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Address Line | 106 W OSBORN RD # 1133
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City | PHOENIX
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State | AZ
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Zip | 85013-3909
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Country | US
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Telephone | 480-360-2039
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Fax | 909-265-9445
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONATHAN SONG
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Credential | DO
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Telephone | 480-360-2039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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