Provider Demographics
NPI:1144393166
Name:SONG OBGYN
Entity Type:Organization
Organization Name:SONG OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-581-4696
Mailing Address - Street 1:11311 BRIDGEPORT WAY SW
Mailing Address - Street 2:#302
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499
Mailing Address - Country:US
Mailing Address - Phone:253-581-4696
Mailing Address - Fax:253-581-9001
Practice Address - Street 1:11311 BRIDGEPORT WAY SW
Practice Address - Street 2:#302
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-581-4696
Practice Address - Fax:253-581-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026796207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1302116Medicaid
WA50D0866316OtherCLIA
WAG001001916Medicare PIN
WA1302116Medicaid