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General NPI Number Information
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NPI Number | 1831211820
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Entity Type | Organization
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Legal Business Name | DAE H SONG DDS INC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 3129 N SAN FERNANDO RD
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City | LOS ANGELES
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State | CA
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Zip | 90065-1412
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Country | US
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Telephone | 323-257-7744
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Fax | 323-257-5430
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Provider Business Mailing Address
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Address Line | 3129 N SAN FERNANDO RD
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City | LOS ANGELES
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State | CA
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Zip | 90065-1412
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Country | US
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Telephone | 323-257-7744
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Fax | 323-257-5430
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAE H SONG
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Credential | D.D.S
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Telephone | 323-257-7744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 25630
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License Number State | CA
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