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General NPI Number Information
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NPI Number | 1801298328
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Entity Type | Individual
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Provider Name | MYUNGSEOK SONG
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Gender | Male
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 30 KINDERKAMACK RD STE 2
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City | ORADELL
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State | NJ
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Zip | 07649-2664
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Country | US
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Telephone | 201-554-5559
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Fax |
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Provider Business Mailing Address
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Address Line | 944 BANTA PL APT A
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City | RIDGEFIELD
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State | NJ
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Zip | 07657-3710
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Country | US
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Telephone | 201-554-5559
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 16014
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License Number State | CA
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