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General NPI Number Information
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NPI Number | 1659646354
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Entity Type | Organization
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Legal Business Name | SAE RYOUNG SONG, M.D., P.A.
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 6245 STATE ROAD 54
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City | NEW PORT RICHEY
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State | FL
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Zip | 34653-6006
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Country | US
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Telephone | 727-846-9496
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Fax | 727-849-8410
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Provider Business Mailing Address
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Address Line | 6245 STATE ROAD 54
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City | NEW PORT RICHEY
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State | FL
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Zip | 34653-6006
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Country | US
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Telephone | 727-846-9496
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Fax | 727-849-8410
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Authorized Official
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Title or Position | PSYCHIATRIST/OWNER
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Name | DR. SAE R SONG
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Credential | M.D.
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Telephone | 727-846-9496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME0029968
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License Number State | FL
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