MEDICARE: DR. DENNIS HYUN SON M.D.

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	2085R0202X	Diagnostic Radiology Physician	A83071	CA
2	2085R0204X	Vascular & Interventional Radiology Physician	A83071	CA
3	2085R0202X	Diagnostic Radiology Physician	12432	NV

General Provider Information

NPI Number	:	1619198272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS HYUN SON M.D.

Provider Business Mailing Address
First Line	:	5317 HERITAGE PL
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4986
Country	:	US
Telephone Number	:	310-713-9601
Fax Number	:

Provider Business Practice Location Address
First Line	:	5317 HERITAGE PL
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4986
Country	:	US
Telephone Number	:	310-713-9601
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	01/20/2012

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