MEDICARE: KEVIN K SONG, DMD,PC

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	1223G0001X	General Practice Dentistry	18858	MA

General Provider Information

NPI Number	:	1952595027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN K SONG, DMD,PC

Provider Business Mailing Address
First Line	:	595 HANCOCK ST
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02170-1911
Country	:	US
Telephone Number	:	617-769-0888
Fax Number	:	617-479-9888

Provider Business Practice Location Address
First Line	:	595 HANCOCK ST
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02170-1911
Country	:	US
Telephone Number	:	617-769-0888
Fax Number	:	617-479-9888

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KEVIN K SONG
Credential	:	D.M.D
Telephone Number	:	617-769-0888

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	08/31/2007

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