Provider Demographics
NPI:1093282642
Name:SONG, BRIAN BYUNG (DR)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:BYUNG
Last Name:SONG
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 ENA RD
Mailing Address - Street 2:SUITE 2809
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1713
Mailing Address - Country:US
Mailing Address - Phone:808-376-1506
Mailing Address - Fax:808-200-1147
Practice Address - Street 1:469 ENA RD.
Practice Address - Street 2:SUITE 2809
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1713
Practice Address - Country:US
Practice Address - Phone:808-798-8753
Practice Address - Fax:808-200-1147
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PT4473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist