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General NPI Number Information
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NPI Number | 1790325306
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Entity Type | Individual
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Provider Name | WON SONG RN
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Gender | Male
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Dates
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Enumeration Date | 01/11/2020
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Last Update Date | 01/11/2020
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Provider Practice Location Address
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Address Line | 907 W BOONE AVE STE B
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City | SPOKANE
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State | WA
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Zip | 99201-2503
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Country | US
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Telephone | 240-899-0319
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Fax |
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Provider Business Mailing Address
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Address Line | 5430 W RAIL CANYON RD
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City | DEER PARK
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State | WA
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Zip | 99006-9430
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Country | US
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Telephone | 240-899-0319
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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