=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609687201
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEE NA SONG MD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2025
-----------------------------------------------------
Last Update Date | 06/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 87 SCRIPPS DR STE 210
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95825-6381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-475-4079
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 87 SCRIPPS DR STE 210
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95825-6381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-475-4075
-----------------------------------------------------
Fax | 916-848-0438
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. MEE NA SONG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 916-425-2399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------