Provider Demographics
NPI:1114143211
Name:JANN, SONG SIAMENG (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SONG
Middle Name:SIAMENG
Last Name:JANN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13795 NIGHTINGALE CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-5513
Mailing Address - Country:US
Mailing Address - Phone:909-684-0025
Mailing Address - Fax:
Practice Address - Street 1:5131 NELLIE CT
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-5132
Practice Address - Country:US
Practice Address - Phone:213-841-4181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14795363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical