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General NPI Number Information
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NPI Number | 1952595027
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Entity Type | Organization
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Legal Business Name | KEVIN K SONG, DMD,PC
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | 595 HANCOCK ST
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City | QUINCY
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State | MA
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Zip | 02170-1911
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Country | US
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Telephone | 617-769-0888
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Fax | 617-479-9888
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Provider Business Mailing Address
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Address Line | 595 HANCOCK ST
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City | QUINCY
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State | MA
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Zip | 02170-1911
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Country | US
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Telephone | 617-769-0888
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Fax | 617-479-9888
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN K SONG
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Credential | D.M.D
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Telephone | 617-769-0888
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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 | 18858
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License Number State | MA
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