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General NPI Number Information
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NPI Number | 1316154115
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Entity Type | Individual
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Provider Name | CHUYOUN SONG L.AC
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Gender | Female
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 555 W REDONDO BEACH BLVD
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City | GARDENA
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State | CA
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Zip | 90248-1612
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Country | US
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Telephone | 310-323-9001
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Fax | 310-756-0004
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Provider Business Mailing Address
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Address Line | 6332 BROCKTON AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-2032
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Country | US
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Telephone | 951-276-0012
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Fax | 951-276-0036
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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 | AC 10654
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License Number State | CA
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