Provider Demographics
NPI:1033699889
Name:SONG, HYUN KYUNG
Entity Type:Individual
Prefix:
First Name:HYUN
Middle Name:KYUNG
Last Name:SONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15318 ROY ROGERS DR
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-2160
Mailing Address - Country:US
Mailing Address - Phone:760-952-7555
Mailing Address - Fax:760-952-8065
Practice Address - Street 1:15318 ROY ROGERS DR
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-2160
Practice Address - Country:US
Practice Address - Phone:760-952-7555
Practice Address - Fax:760-952-8065
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist