MEDICARE: DR. JOOYOUNG SONG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	DDS108828	CA

General Provider Information

NPI Number	:	1225535073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOOYOUNG SONG DDS

Provider Business Mailing Address
First Line	:	28212 KELLY JOHNSON PKWY STE 290
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-5093
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28212 KELLY JOHNSON PKWY STE 290
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-5093
Country	:	US
Telephone Number	:	888-700-6623
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	08/16/2023

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