Provider Demographics
NPI:1013193051
Name:SONG, ANDREW YU (LAC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:YU
Last Name:SONG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 DULUTH ST STE 317
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3957
Mailing Address - Country:US
Mailing Address - Phone:716-546-9188
Mailing Address - Fax:
Practice Address - Street 1:5851 DULUTH ST STE 317
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-3957
Practice Address - Country:US
Practice Address - Phone:716-546-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-19
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1194171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist