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General NPI Number Information
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NPI Number | 1629363908
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Entity Type | Organization
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Legal Business Name | BYRON T SONG, M.D. INC
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Dates
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Enumeration Date | 06/14/2011
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Last Update Date | 06/14/2011
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Provider Practice Location Address
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Address Line | 415 W CARROLL AVE SUITE 202
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City | GLENDORA
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State | CA
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Zip | 91741-4208
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Country | US
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Telephone | 626-963-1627
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Fax | 626-963-0467
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Provider Business Mailing Address
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Address Line | 415 W CARROLL AVE SUITE 202
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City | GLENDORA
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State | CA
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Zip | 91741-4208
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Country | US
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Telephone | 626-963-1627
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Fax | 626-963-0467
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Authorized Official
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Title or Position | CORP. SECRETARY
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Name | DONNA LEE SONG
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Credential | RN
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Telephone | 626-963-1627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A21194
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License Number State | CA
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