Provider Demographics
NPI:1023357035
Name:SONG, KAYLIN SOHYUN (DC)
Entity Type:Individual
Prefix:
First Name:KAYLIN
Middle Name:SOHYUN
Last Name:SONG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SO
Other - Middle Name:HYUN
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:131 CIMARRON TRL APT 2028
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-8558
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2720 ROYAL LN
Practice Address - Street 2:190
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-4724
Practice Address - Country:US
Practice Address - Phone:469-401-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor