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General NPI Number Information
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NPI Number | 1922286186
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Entity Type | Individual
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Provider Name | ANDREW SONG D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/08/2008
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Last Update Date | 02/11/2017
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Provider Practice Location Address
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Address Line | 11175 CAMPUS ST A1117
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City | LOMA LINDA
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State | CA
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Zip | 92350-1700
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Country | US
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Telephone | 323-268-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 11175 CAMPUS ST A1117
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City | LOMA LINDA
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State | CA
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Zip | 92350-1700
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 20A10661
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License Number State | CA
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