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General NPI Number Information
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NPI Number | 1740801646
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Entity Type | Organization
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Legal Business Name | SONG DERMATOLOGY PLLC
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Dates
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Enumeration Date | 05/01/2020
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 1428 W HEBRON PKWY STE 120
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City | CARROLLTON
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State | TX
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Zip | 75010-6347
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Country | US
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Telephone | 972-215-7855
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Fax | 469-284-5543
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Provider Business Mailing Address
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Address Line | 3500 MATAGORDA SPRINGS DR
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City | PLANO
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State | TX
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Zip | 75025-6808
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Country | US
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Telephone | 972-786-5481
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Fax |
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Authorized Official
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Title or Position | DERMATOLOGIST
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Name | MI HYE SONG
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Credential | MD
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Telephone | 972-786-5481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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