Provider Demographics
NPI:1255484499
Name:SONG, BYUNG CHAN (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:BYUNG
Middle Name:CHAN
Last Name:SONG
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 W. OLYMPIC BL. #440
Mailing Address - Street 2:#440
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2494
Mailing Address - Country:US
Mailing Address - Phone:323-730-8080
Mailing Address - Fax:323-732-8342
Practice Address - Street 1:3130 W. OLYMPIC BL. #440
Practice Address - Street 2:#440
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2494
Practice Address - Country:US
Practice Address - Phone:323-730-8080
Practice Address - Fax:323-732-8342
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALAC 2808171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist