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General NPI Number Information
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NPI Number | 1912624842
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Entity Type | Organization
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Legal Business Name | SEUNG YUB SONG DDS LLC
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Dates
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Enumeration Date | 10/21/2022
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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 | OWNER
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Name | SEUNG YUB SONG
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Credential |
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Telephone | 646-656-0362
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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 |
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License Number State |
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