Provider Demographics
NPI:1174256267
Name:SONG, KUHN H (DDS)
Entity Type:Individual
Prefix:
First Name:KUHN
Middle Name:H
Last Name:SONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:H
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:14430 OVERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-7726
Mailing Address - Country:US
Mailing Address - Phone:317-670-2989
Mailing Address - Fax:
Practice Address - Street 1:14430 OVERBROOK DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46074-7726
Practice Address - Country:US
Practice Address - Phone:317-670-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013817A1223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty