Provider Demographics
NPI:1053488791
Name:SONG, YI (LIC AC)
Entity Type:Individual
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First Name:YI
Middle Name:
Last Name:SONG
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Gender:F
Credentials:LIC AC
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Mailing Address - Street 1:1834 CENTRE ST
Mailing Address - Street 2:UNIT 320594
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-0230
Mailing Address - Country:US
Mailing Address - Phone:617-344-1441
Mailing Address - Fax:617-206-3889
Practice Address - Street 1:60 STATE ST
Practice Address - Street 2:SUITE 700
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-1800
Practice Address - Country:US
Practice Address - Phone:617-344-1441
Practice Address - Fax:617-206-3889
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2014-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA223246171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist