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General NPI Number Information
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NPI Number | 1962720425
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Entity Type | Individual
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Provider Name | KIMBERLY SONG MD
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Gender | Female
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Dates
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Enumeration Date | 05/08/2010
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 8318 4TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-4413
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Country | US
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Telephone | 718-748-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 408 E 92ND ST APT 23A
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City | NEW YORK
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State | NY
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Zip | 10128-6838
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 295045-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 295045-1
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License Number State | NY
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