MEDICARE: LUCY SONG 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	207RH0003X	Hematology & Oncology Physician	G83036	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699771030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCY SONG M.D.

Provider Business Mailing Address
First Line	:	710 LAWRENCE EXPY
Second Line	:	ONCOLOGY DEPT #440
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-5173
Country	:	US
Telephone Number	:	408-851-4323
Fax Number	:	408-851-4319

Provider Business Practice Location Address
First Line	:	710 LAWRENCE EXPY
Second Line	:	ONCOLOGY DEPT #440
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-5173
Country	:	US
Telephone Number	:	408-851-4323
Fax Number	:	408-851-4319

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2007

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