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General NPI Number Information
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NPI Number | 1831787084
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Entity Type | Individual
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Provider Name | JINA SONG OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 12401 WASHINGTON BLVD
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City | WHITTIER
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State | CA
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Zip | 90602-1006
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Country | US
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Telephone | 562-698-0811
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Fax |
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Provider Business Mailing Address
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Address Line | 14703 JALISCO RD
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City | LA MIRADA
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State | CA
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Zip | 90638-4426
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Country | US
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Telephone | 562-665-3727
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 21415
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License Number State | CA
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