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General NPI Number Information
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NPI Number | 1881086866
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Entity Type | Individual
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Provider Name | YEONSU SONG RN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/27/2015
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Last Update Date | 02/05/2017
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Provider Practice Location Address
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Address Line | 5690 CONISTON WAY
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City | SAN JOSE
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State | CA
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Zip | 95118-3517
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Country | US
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Telephone | 415-318-9173
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Fax |
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Provider Business Mailing Address
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Address Line | 5690 CONISTON WAY
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City | SAN JOSE
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State | CA
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Zip | 95118-3517
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95000459
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 653587
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License Number State | CA
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