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General NPI Number Information
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NPI Number | 1982903878
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Entity Type | Individual
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Provider Name | QIJUN SONG LSA, SA-C
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Gender | Female
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Dates
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Enumeration Date | 03/18/2011
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Last Update Date | 08/15/2016
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Provider Practice Location Address
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Address Line | 475 BENDWOOD DR
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City | HOUSTON
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State | TX
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Zip | 77024-8813
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Country | US
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Telephone | 281-409-3854
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Fax | 832-201-7900
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Provider Business Mailing Address
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Address Line | PO BOX 79576
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City | HOUSTON
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State | TX
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Zip | 77279-9576
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Country | US
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Telephone | 513-312-2223
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Fax | 832-201-7900
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 11-114
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | SA00504
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License Number State | TX
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