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General NPI Number Information
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NPI Number | 1831900638
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Entity Type | Organization
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Legal Business Name | SONG MEDICAL GROUP INC
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 12665 GARDEN GROVE BLVD STE 503
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1919
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Country | US
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Telephone | 714-530-3740
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Fax |
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Provider Business Mailing Address
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Address Line | 12665 GARDEN GROVE BLVD STE 503
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1919
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Country | US
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Telephone | 714-530-3740
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Fax |
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Authorized Official
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Title or Position | PRESIDENT /MD
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Name | CHAE WON SONG
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Credential | MD
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Telephone | 714-530-3740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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