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General NPI Number Information
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NPI Number | 1508737024
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Entity Type | Individual
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Provider Name | HANNAH SONG
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Gender |
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Dates
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Enumeration Date | 09/16/2025
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 1141 W REDONDO BEACH BLVD STE 306
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City | GARDENA
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State | CA
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Zip | 90247-3583
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Country | US
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Telephone | 310-834-5388
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Fax |
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Provider Business Mailing Address
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Address Line | 4329 REDWOOD AVE UNIT 3
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6426
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 95035324
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License Number State | CA
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