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General NPI Number Information
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NPI Number | 1306191697
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Entity Type | Individual
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Provider Name | MIN HO SONG MFT INTERN
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Gender | Male
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 07/23/2012
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Provider Practice Location Address
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Address Line | 1721 N BROADWAY
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City | LOS ANGELES
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State | CA
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Zip | 90031-1763
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Country | US
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Telephone | 323-342-2808
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Fax | 323-275-9233
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Provider Business Mailing Address
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Address Line | 1721 N BROADWAY
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City | LOS ANGELES
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State | CA
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Zip | 90031-1763
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Country | US
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Telephone | 323-342-2808
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Fax | 323-275-9233
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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