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General NPI Number Information
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NPI Number | 1942519392
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Entity Type | Organization
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Legal Business Name | TAE J SONG DPM INC
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Dates
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Enumeration Date | 10/04/2010
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 1310 CONTINENTAL ST
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City | REDDING
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State | CA
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Zip | 96001-0839
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Country | US
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Telephone | 530-244-0674
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Fax | 530-244-1033
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Provider Business Mailing Address
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Address Line | 1310 CONTINENTAL ST
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City | REDDING
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State | CA
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Zip | 96001-0839
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Country | US
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Telephone | 530-244-0674
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Fax | 530-244-1033
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TAE J SONG
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Credential | DPM
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Telephone | 530-244-0674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E4771
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License Number State | CA
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