MEDICARE: SONG PERIODONTICS AND DENTAL IMPLANTS PLLC

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	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1386202539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONG PERIODONTICS AND DENTAL IMPLANTS PLLC

Provider Business Mailing Address
First Line	:	411 STRANDER BLVD STE 302
Second Line	:
City	:	TUKWILA
State	:	WA
Zip	:	98188-2924
Country	:	US
Telephone Number	:	206-575-1086
Fax Number	:	206-575-0829

Provider Business Practice Location Address
First Line	:	411 STRANDER BLVD STE 302
Second Line	:
City	:	TUKWILA
State	:	WA
Zip	:	98188-2924
Country	:	US
Telephone Number	:	206-575-1086
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HYUN SONG
Credential	:	DDS
Telephone Number	:	206-575-1086

Provider Enumeration Date	:	06/03/2019
Last Update Date	:	01/19/2026

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