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General NPI Number Information
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NPI Number | 1871807693
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Entity Type | Individual
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Provider Name | SEUNG YUB SONG D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 10/21/2022
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Provider Practice Location Address
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Address Line | 495 CONNECTICUT AVE
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City | NORWALK
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State | CT
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Zip | 06854-1723
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Country | US
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Telephone | 646-656-0362
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Fax |
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Provider Business Mailing Address
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Address Line | 36 DECATUR ST APT 2
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City | COS COB
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State | CT
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Zip | 06807-2159
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10335
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License Number State | CT
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