Provider Demographics
NPI:1013367200
Name:SONG, BETTY SIHUI (MD)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:SIHUI
Last Name:SONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:SIHUI
Other - Last Name:YAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:981 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3304
Mailing Address - Country:US
Mailing Address - Phone:909-667-7769
Mailing Address - Fax:909-667-7745
Practice Address - Street 1:981 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3304
Practice Address - Country:US
Practice Address - Phone:909-667-7769
Practice Address - Fax:909-667-7745
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125068714207N00000X
CAA168835207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology